Yuesong Pan1, Jing Jing1, Weiqi Chen1, Xia Meng1, Hao Li1, Xingquan Zhao1, Liping Liu1, David Wang1, S Claiborne Johnston1, Yilong Wang2, Yongjun Wang2. 1. From the Department of Neurology (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics (Y.P.), School of Public Health, Capital Medical University, Beijing, China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin. 2. From the Department of Neurology (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., J.J., W.C., X.M., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics (Y.P.), School of Public Health, Capital Medical University, Beijing, China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin. yongjunwang1962@gmail.com yilong528@gmail.com.
Abstract
OBJECTIVE: To investigate the short-term time course risks and benefits of clopidogrel with aspirin in minor ischemic stroke or TIA. METHODS: Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. The primary outcome was a new ischemic stroke. Safety outcomes included any bleeding and moderate to severe bleeding. Time course analyses were performed for the outcomes of both stroke and bleeding. RESULTS: A total of 145 (71.1%), 13 (6.4%), and 12 (5.9%) of 204 new ischemic strokes in the clopidogrel-aspirin group vs 223 (75.6%), 19 (6.4%), and 8 (2.7%) of 295 in the aspirin alone group occurred at the first, second, and third week, respectively. A total of 23 (38.3%), 15 (25.0%), and 9 (15.0%) of 60 bleeding cases in the clopidogrel-aspirin group vs 15 (36.6%), 8 (19.5%), and 3 (7.3%) of 41 in the aspirin alone group occurred at the first, second, and third week, respectively. Clopidogrel-aspirin treatment numerically reduced the risk of ischemic stroke within the first 2 weeks. From the 10th day, the number of any bleeding cases caused by dual antiplatelets outweighed that of new stroke reduced by dual antiplatelets. CONCLUSIONS: Clopidogrel-aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. CLINICALTRIALSGOV IDENTIFIER: NCT00979589. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
OBJECTIVE: To investigate the short-term time course risks and benefits of clopidogrel with aspirin in minor ischemic stroke or TIA. METHODS: Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. The primary outcome was a new ischemic stroke. Safety outcomes included any bleeding and moderate to severe bleeding. Time course analyses were performed for the outcomes of both stroke and bleeding. RESULTS: A total of 145 (71.1%), 13 (6.4%), and 12 (5.9%) of 204 new ischemic strokes in the clopidogrel-aspirin group vs 223 (75.6%), 19 (6.4%), and 8 (2.7%) of 295 in the aspirin alone group occurred at the first, second, and third week, respectively. A total of 23 (38.3%), 15 (25.0%), and 9 (15.0%) of 60 bleeding cases in the clopidogrel-aspirin group vs 15 (36.6%), 8 (19.5%), and 3 (7.3%) of 41 in the aspirin alone group occurred at the first, second, and third week, respectively. Clopidogrel-aspirin treatment numerically reduced the risk of ischemic stroke within the first 2 weeks. From the 10th day, the number of any bleeding cases caused by dual antiplatelets outweighed that of new stroke reduced by dual antiplatelets. CONCLUSIONS: Clopidogrel-aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. CLINICALTRIALSGOV IDENTIFIER: NCT00979589. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
Authors: Victor J Del Brutto; Seemant Chaturvedi; Hans-Christoph Diener; Jose G Romano; Ralph L Sacco Journal: J Am Coll Cardiol Date: 2019-08-13 Impact factor: 24.094
Authors: Patrizia Natale; Suetonia C Palmer; Valeria M Saglimbene; Marinella Ruospo; Mona Razavian; Jonathan C Craig; Meg J Jardine; Angela C Webster; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2022-02-28
Authors: Jaqui Walker; Pippa Hutchison; Junbo Ge; Dong Zhao; Yongjun Wang; Peter M Rothwell; J Michael Gaziano; Andrew Chan; John Burn; John Chia; Ruth Langley; Valerie O'Donnell; Bianca Rocca; Chris Hawkey Journal: Ecancermedicalscience Date: 2018-02-20