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Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data

Nai-Fang Chi1,2,3, Chi-Pang Wen4, Chung-Hsiang Liu5

  • 11 Department of Neurology School of Medicine College of Medicine Taipei Medical University Taipei Taiwan.

Journal of the American Heart Association
|October 30, 2018
PubMed

Insights

In real-world practice, clopidogrel showed similar effectiveness to aspirin for preventing recurrent ischemic strokes. However, clopidogrel use was associated with a significantly higher mortality rate compared to aspirin.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Previous clinical trials suggested clopidogrel's superiority over aspirin for secondary vascular prevention.
  • Real-world data is crucial to validate these findings in diverse patient populations.

Purpose of the Study:

  • To compare the safety and efficacy of clopidogrel versus aspirin for secondary stroke prevention in a real-world setting.
  • To assess stroke recurrence and mortality rates between the two antiplatelet therapies.

Main Methods:

  • Retrospective analysis of ischemic stroke patients (2006-2016) from the Taiwan Stroke Registry.
  • Comparison of stroke recurrence and mortality between aspirin and clopidogrel groups.
  • Propensity score matching and Cox regression to control for confounding factors.

Main Results:

  • Stroke recurrence rates were comparable between aspirin and clopidogrel groups after propensity score matching (HR=1.13, P=0.311).
  • Mortality rate was significantly higher in the clopidogrel group compared to the aspirin group (HR=1.30, P=0.008).
  • Findings remained consistent before and after propensity score adjustment.

Conclusions:

  • Clopidogrel is as effective as aspirin in preventing recurrent ischemic stroke in real-world clinical practice.
  • Aspirin demonstrated a better safety profile regarding mortality compared to clopidogrel.

Keywords:
aspirinclopidogrelpreventionstroke

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