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Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy
Xianwei Wang1, Xingquan Zhao1, S Claiborne Johnston1
1From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
Insights
Dual antiplatelet therapy with clopidogrel and aspirin significantly improved functional outcomes for patients with acute minor stroke or transient ischemic attack (TIA). This combination therapy reduced the risk of poor functional outcomes and disabling strokes compared to aspirin alone.
Area of Science:
- Neurology
- Cardiology
- Clinical Trials
Background:
- Minor stroke and transient ischemic attack (TIA) are critical cerebrovascular events.
- Optimal antiplatelet therapy for acute minor stroke or TIA remains an area of active research.
- The CHANCE trial investigated dual antiplatelet therapy versus single antiplatelet therapy.
Purpose of the Study:
- To compare the efficacy of clopidogrel plus aspirin versus aspirin alone on functional outcomes and quality of life in patients with acute minor stroke or TIA.
- To evaluate the impact of dual antiplatelet therapy on the rate of disabling stroke.
Main Methods:
- The study enrolled patients with acute minor stroke or TIA.
- Participants received either clopidogrel plus aspirin or aspirin alone.
- Functional outcome was assessed at 90 days using the modified Rankin Scale (mRS), and quality of life using the EuroQol-5 Dimension (EQ-5D).
Main Results:
- Poor functional outcome (mRS 2-6) occurred in 9.9% of the clopidogrel-aspirin group versus 11.6% in the aspirin group (p=0.046).
- Disabling stroke at 90 days occurred in 6.5% of the clopidogrel-aspirin group versus 8.5% in the aspirin group (p=0.01).
- Quality of life showed a trend towards improvement with dual antiplatelet therapy (p=0.06).
Conclusions:
- Clopidogrel plus aspirin is superior to aspirin alone in improving 90-day functional outcomes for patients with minor stroke or TIA.
- Dual antiplatelet therapy reduces the rate of disabling stroke in this patient population.
- The findings support the use of clopidogrel plus aspirin for acute minor stroke or TIA management.
Objective:
We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA.
Methods:
Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less.
Results:
Poor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups.
Conclusions:
In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm.
Classification Of Evidence:
This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%-3.42%).
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