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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effects With and Without Clopidogrel Loading Treatment for Acute Ischemic Cerebrovascular Disease Patients: A
Yasuko Ikeda-Sakai1, Masahiro Sasaki1, Taizen Nakase1
1Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
Insights
Clopidogrel loading treatment did not significantly differ from non-loading treatment for acute ischemic stroke. However, clopidogrel loading was ineffective for branch atheromatous disease, suggesting subtype-specific treatment choices.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Acute ischemic cerebrovascular disease requires prompt and effective treatment.
- Clopidogrel is a commonly used antiplatelet agent, but its optimal dosing strategy, particularly loading doses, remains under investigation for specific stroke subtypes.
Purpose of the Study:
- To compare the effectiveness of clopidogrel loading (CL) treatment versus usual clopidogrel non-loading (NL) treatment in preventing neurologic deterioration in patients with acute ischemic cerebrovascular disease.
Main Methods:
- A prospective study involving 224 patients with ischemic cerebrovascular disease within 48 hours of symptom onset.
- Patients were divided into a CL group (300 mg day 1, then 50-75 mg daily) and an NL group (50-75 mg daily).
- Logistic regression analysis was used to compare the incidence of neurologic deterioration between groups.
Main Results:
- No significant difference in neurologic deterioration was observed between the CL and NL groups (risk ratio: 1.47 [0.88-2.46]).
- Subgroup analysis revealed a significantly higher rate of neurologic deterioration in the CL group for branch atheromatous disease (risk ratio: 2.44 [1.67-3.55]).
- No significant difference in adverse events was noted between the groups.
Conclusions:
- Clopidogrel loading therapy's effectiveness varies by stroke subtype.
- CL therapy appears ineffective for branch atheromatous disease.
- Treatment decisions for clopidogrel loading should be individualized based on stroke subtype.
Objectives:
We investigated the effectiveness of clopidogrel loading (CL) treatment compared with usual clopidogrel non-loading (NL) treatment for acute ischemic cerebrovascular disease.
Methods:
We screened consecutive 1072 patients with ischemic cerebrovascular disease within 48 hours of symptom onset admitted to our hospital. Eligible patients were divided into the CL group (300 mg on day 1, followed by 50-75 mg once daily) and NL group (50-75 mg once daily). The incidence proportion of neurologic deterioration during hospitalization was compared between the 2 groups using logistic regression analysis.
Results:
A total of 224 patients, 39 in CL group and 185 in NL group, were enrolled. The frequency of neurologic deterioration did not significantly differ between the 2 groups (risk ratio [95% confidence interval]: 1.47 [.88-2.46]). On the preset subgroup analysis according to stroke subtype, the frequency of neurologic deterioration in CL group was significantly higher in branch atheromatous disease (risk ratio: 2.44 [1.67-3.55]) and was not different statistically in transient ischemic attack (risk ratio: 0). The analysis adjusted by several confounders showed that the incidence proportion of neurologic deterioration was not significantly different in large artery atherosclerosis (adjusted odds ratio: 1.06 [.23-4.84]) as crude analysis. The incidence proportion of adverse events was not significantly different between the 2 groups.
Conclusions:
The effect of CL therapy differed by stroke subtypes in preventing neurologic deterioration. CL therapy appeared to be ineffective in branch atheromatous disease. Therefore, the choice of CL therapy should carefully be made according to stroke subtypes.
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