Key result
Clopidogrel plus aspirin reduced 90-day recurrent stroke compared to aspirin alone in patients with lower glycated albumin (HR 0.40; 95% CI 0.26-0.61), but not in those with elevated levels.
Why the study?
Does dual antiplatelet therapy with clopidogrel and aspirin reduce recurrent stroke compared to aspirin alone differently based on baseline glycated albumin levels in patients with minor ischemic stroke or TIA?
RCT (n=3,044)
randomized
Yes
Does dual antiplatelet therapy with clopidogrel and aspirin reduce recurrent stroke compared to aspirin alone differently based on baseline glycated albumin levels in patients with minor ischemic stroke or TIA?
Hazard Ratio: 0.4 (95% CI 0.26–0.61)
Absolute Event Rate: 5.5% vs 12.7%
p-value: p=<0.001
Glycated albumin levels may help identify which patients with minor stroke or TIA will benefit most from dual antiplatelet therapy with clopidogrel and aspirin.
Glycated albumin may guide dual antiplatelet therapy selection after minor stroke or TIA; extends RCT subgroup evidence for biomarker-driven secondary prevention.
OBJECTIVE: To determine the relationship of glycated albumin (GA) and the recurrence of stroke in patients on either dual or single antiplatelet therapy. METHODS: The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of 3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified clinical sites was analyzed. Patients were categorized into 2 groups based on GA level of 15.5%, the cut point for development of diabetes. The primary outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models were used to assess the interaction of GA with randomized antiplatelet therapy on their risk of recurrent stroke. RESULTS: Significant interaction of GA levels with the 2 antiplatelet therapy groups was found after adjustment for age, sex, and other conventional confounding factors (p = 0.009). The interaction remained consistent after further adjustment for history of diabetes (p = 0.010). In patients with lower GA level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and 12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and 11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103). CONCLUSIONS: GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.
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Li et al. (2015) conducted an RCT in minor ischemic stroke or TIA (n=3,044). Clopidogrel plus aspirin vs. Aspirin alone was evaluated on Stroke recurrence during 90-day follow-up (HR 0.40, 95% CI 0.26-0.61, p=<0.001). Clopidogrel plus aspirin reduced 90-day recurrent stroke compared to aspirin alone in patients with lower glycated albumin (HR 0.40; 95% CI 0.26-0.61), but not in those with elevated levels.
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