Hak-Loh Lee1, Joon-Tae Kim1, Ji Sung Lee2, Man-Seok Park1, Kang-Ho Choi1, Ki-Hyun Cho1, Beom Joon Kim3, Jong-Moo Park4, Kyusik Kang4, Soo Joo Lee5, Jae Guk Kim5, Jae-Kwan Cha6, Dae-Hyun Kim6, Tai Hwan Park7, Sang-Soon Park7, Kyung Bok Lee8, Jun Lee9, Keun-Sik Hong10, Yong-Jin Cho10, Hong-Kyun Park10, Byung-Chul Lee11, Kyung-Ho Yu11, Mi Sun Oh11, Dong-Eog Kim12, Wi-Sun Ryu12, Jay Chol Choi13, Jee-Hyun Kwon14, Wook-Joo Kim14, Dong-Ick Shin15, Sung Il Sohn16, Jeong-Ho Hong16, Juneyoung Lee17, Hee-Joon Bae3. 1. Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho). 2. Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.). 3. Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., H.-J.B.). 4. Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea (J.-M.P., K.K.). 5. Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.). 6. Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.). 7. Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.). 8. Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.). 9. Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.). 10. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.). 11. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.). 12. Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.). 13. Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Korea (J.C.C.). 14. Department of Neurology, Ulsan University College of Medicine, Korea (J.-H.K., W.-J.K.). 15. Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S.). 16. Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.). 17. Department of Biostatistics, Korea University College of Medicine, BK21FOUR Program in Learning Health Systems, Korea University, Seoul (J.L.).
Abstract
BACKGROUND: This study compared the effectiveness of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin with that of aspirin monotherapy (AM) in mild-to-moderate acute ischemic stroke considering the risk of recurrent stroke using the Stroke Prognosis Instrument II (SPI-II) score. METHODS: This study is a retrospective analysis of data from a prospective, nationwide, multicenter stroke registry database between January 2011 and July 2018. We included patients with mild-to-moderate (National Institutes of Health Stroke Scale score ≤10), acute (within 24 hours of onset), noncardioembolic ischemic stroke. The primary outcome was a 3-month composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality. Propensity scores using the inverse probability of treatment weighting method were used to mitigate baseline imbalances between the DAPT and AM groups and within each subgroup considering SPI-II scores. RESULTS: Among the 15 430 patients (age, 66±13 years; men, 62.0%), 45.1% (n=6960) received DAPT and 54.9% (n=8470) received AM. Primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%; P=0.03). Weighted Cox proportional hazards models showed a reduced risk of 3-month primary vascular events in the DAPT group versus the AM group (hazard ratio, 0.84 [0.78-0.92]; P<0.001), with no interaction between acute treatment type and SPI-II risk subgroups (Pinteraction=0.44). However, among the high-risk patients with SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group (weighted absolute risk differences, 5.4%), whereas smaller absolute benefits were observed among patients in the low- or medium-risk SPI-II subgroups (1.7% and 2.4%, respectively). CONCLUSIONS: Treatment with clopidogrel-aspirin was associated with a reduction in 3-month vascular events compared with AM in mild-to-moderate acute noncardioembolic ischemic stroke patients. Larger magnitudes of the effects of DAPT with clopidogrel-aspirin were observed in the high-risk subgroup by SPI-II risk scores.
BACKGROUND: This study compared the effectiveness of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin with that of aspirin monotherapy (AM) in mild-to-moderate acute ischemic stroke considering the risk of recurrent stroke using the Stroke Prognosis Instrument II (SPI-II) score. METHODS: This study is a retrospective analysis of data from a prospective, nationwide, multicenter stroke registry database between January 2011 and July 2018. We included patients with mild-to-moderate (National Institutes of Health Stroke Scale score ≤10), acute (within 24 hours of onset), noncardioembolic ischemic stroke. The primary outcome was a 3-month composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality. Propensity scores using the inverse probability of treatment weighting method were used to mitigate baseline imbalances between the DAPT and AM groups and within each subgroup considering SPI-II scores. RESULTS: Among the 15 430 patients (age, 66±13 years; men, 62.0%), 45.1% (n=6960) received DAPT and 54.9% (n=8470) received AM. Primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%; P=0.03). Weighted Cox proportional hazards models showed a reduced risk of 3-month primary vascular events in the DAPT group versus the AM group (hazard ratio, 0.84 [0.78-0.92]; P<0.001), with no interaction between acute treatment type and SPI-II risk subgroups (Pinteraction=0.44). However, among the high-risk patients with SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group (weighted absolute risk differences, 5.4%), whereas smaller absolute benefits were observed among patients in the low- or medium-risk SPI-II subgroups (1.7% and 2.4%, respectively). CONCLUSIONS: Treatment with clopidogrel-aspirin was associated with a reduction in 3-month vascular events compared with AM in mild-to-moderate acute noncardioembolic ischemic strokepatients. Larger magnitudes of the effects of DAPT with clopidogrel-aspirin were observed in the high-risk subgroup by SPI-II risk scores.
Authors: Ossama Khazaal; Aaron Rothstein; Muhammad R Husain; Matthew Broderick; Daniel Cristancho; Sahily Reyes-Esteves; Farhan Khan; Christopher G Favilla; Steven R Messé; Michael T Mullen Journal: Front Neurol Date: 2021-09-20 Impact factor: 4.003