What question did this study set out to answer?

To evaluate the efficacy and safety of combining clopidogrel and aspirin compared with aspirin alone in patients treated within 12 hours of acute minor stroke or transient ischemic attack.

March 9, 2016Journal of the American Heart AssociationOpen Access

Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack

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Why the study?

Does the combination of clopidogrel and aspirin reduce ischemic stroke in patients with acute minor stroke or transient ischemic attack treated within 12 hours?

Population

2,573 patients with acute minor stroke or transient ischemic attack randomized within 12 hours

Comparison

Combination therapy of clopidogrel and aspirin vs Aspirin alone

Design

RCT, Randomized within 12 hours

Follow-up

90 days

Authors

ZLZixiao LiVascular / Pulmonary Vascular YWYilong WangVascular Medicine XZXingquan ZhaoNorth Sichuan Medical University

Discussion

Member takes

Implication

Supports early dual antiplatelet therapy in minor stroke or TIA; extends RCT evidence for ischemic stroke reduction.

Key Points

To evaluate the efficacy and safety of combining clopidogrel and aspirin compared with aspirin alone in patients treated within 12 hours of acute minor stroke or transient ischemic attack.
Prespecified subgroup analysis of the randomized CHANCE trial (NCT00979589) evaluating 2,573 patients presenting within 12 hours of acute minor stroke or transient ischemic attack.
Assigned patients to dual therapy with clopidogrel plus aspirin or aspirin monotherapy, tracking primary ischemic stroke outcomes alongside hemorrhagic risk during 90 days of follow-up.
Randomization within 12 hours was an independent predictor of ischemic stroke (HR 1.25, 95% CI 1.04–1.49, P=0.02), with ischemic stroke occurring in 9.59% (124/1,293) of dual-therapy patients versus 12.34% (158/1,280) on aspirin alone (P=0.02).
Dual antiplatelet therapy significantly lowered recurrent ischemic stroke rates compared with aspirin monotherapy (6.57% vs. 8.91%, P=0.03), though progressive ischemic stroke rates did not differ significantly (3.02% vs. 3.43%, P=0.28).
No significant difference in hemorrhagic events occurred between the clopidogrel-aspirin group and the aspirin alone group (P=0.39).

Structured PICO

Does the combination of clopidogrel and aspirin reduce ischemic stroke in patients with acute minor stroke or transient ischemic attack treated within 12 hours?

Population

2,573 patients with acute minor stroke or transient ischemic attack randomized within 12 hours

Intervention

Combination therapy of clopidogrel and aspirin

Comparator

Aspirin alone

Outcome

Ischemic stroke during 90-day follow-uphard clinical

Dual antiplatelet therapy with clopidogrel and aspirin initiated within 12 hours of acute minor stroke or TIA significantly reduces 90-day ischemic stroke risk compared to aspirin alone without increasing bleeding.

Cite This Study

Li et al. (2016) studied this question.

synapsesocial.com/papers/6a80f61ed7cc36764365f322 https://doi.org/10.1161/jaha.115.003038

Topics

Dual antiplatelet therapy

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Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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