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A comparative study of dual versus monoantiplatelet therapy in patients with acute large-artery atherosclerosis
Xingyang Yi1, Jing Lin2, Chun Wang1
1Department of Neurology, People's Hospital of Deyang City, Deyang, Sichuan.
Insights
Dual antiplatelet therapy with clopidogrel and aspirin significantly reduced neurologic deterioration and recurrent ischemic stroke in patients with acute large-artery atherosclerosis stroke compared to aspirin alone.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Acute noncardioembolic stroke management guidelines recommend antiplatelet drugs.
- Limited randomized trials exist on dual antiplatelet therapy (clopidogrel and aspirin) safety and efficacy in this patient group.
- Large-artery atherosclerosis stroke requires further investigation into optimal antiplatelet strategies.
Purpose of the Study:
- To compare dual antiplatelet therapy (clopidogrel and aspirin) versus aspirin monotherapy.
- To evaluate the impact on neurologic deterioration and platelet activation.
- To assess short-term outcomes including stroke recurrence and safety endpoints.
Main Methods:
- Randomized trial of 574 patients with acute large-artery atherosclerosis stroke (≤2 days).
- Treatment groups: combined clopidogrel and aspirin vs. aspirin alone.
- Platelet aggregation and platelet-leukocyte aggregation measured at days 1 and 30; outcomes monitored.
Main Results:
- Lower prevalence of neurologic deterioration (3.52% vs. 9.78%) and recurrent ischemic stroke (1.76% vs. 6.29%) in the combination therapy group.
- Significantly lower platelet aggregation and platelet-leukocyte aggregates at day 30 with dual therapy (P < .001).
Conclusions:
- One-month dual therapy with clopidogrel and aspirin significantly inhibits platelet activity more than aspirin alone.
- Dual therapy demonstrates improved safety and efficacy in reducing ischemic stroke recurrence and neurologic deterioration.
- This supports dual antiplatelet therapy as a beneficial strategy for acute large-artery atherosclerosis stroke.
Background:
Antiplatelet drugs are recommended for patients with acute noncardioembolic stroke. However, few randomized clinical trials have investigated the safety and efficacy of dual antiplatelet therapy for these patients. The aim of this study was to evaluate the effects of treatment with clopidogrel and aspirin (combination therapy) and aspirin alone (monotherapy) on neurologic deterioration, platelet activation, and other short-term outcomes in patients with acute large-artery atherosclerosis stroke.
Materials And Methods:
Altogether 574 patients with acute (≤2 days) large-artery atherosclerosis stroke were randomly assigned to receive either combined clopidogrel and aspirin or aspirin alone. Platelet aggregation and platelet-leukocyte aggregation studies were performed at days 1 and 30. Primary outcomes including recurrent ischemic stroke, neurologic deterioration, periphery vascular events, and myocardial infarction were monitored. Safety endpoints were hemorrhagic episodes and death.
Results:
The prevalence of neurologic deterioration and recurrent ischemic stroke were lower in patients in the combination therapy group than in those of the monotherapy group (3.52% versus 9.78% and 1.76% versus 6.29%, respectively). At day 30 of treatment, the platelet aggregations and platelet-leukocyte aggregates were lower in patients who were treated with clopidogrel and aspirin than in patients given aspirin alone (P < .001).
Conclusions:
For patients with acute large-artery atherosclerosis stroke, treatment with clopidogrel and aspirin for 1 month provided significantly greater inhibition of platelet activity than aspirin alone. Thus, dual therapy can be safer and more effective in reducing ischemic stroke recurrence and neurologic deterioration.
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