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Disability After Minor Stroke and Transient Ischemic Attack in the POINT Trial
Brett Cucchiara1, Jordan Elm2, J Donald Easton3
1From the Department of Neurology, University of Pennsylvania, Philadelphia (B.C.).
Stroke
|February 21, 2020
Summary
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel may reduce stroke-related disability in patients with TIA or minor stroke. This combination therapy showed a significant reduction in disability attributed to the index or recurrent stroke.
Area of Science:
- Neurology
- Cardiology
- Clinical Trials
Background:
- Combination aspirin and clopidogrel therapy is known to reduce recurrent stroke in patients with transient ischemic attack (TIA) or minor stroke.
- However, the impact of this dual antiplatelet therapy (DAPT) on patient disability remains uncertain.
Purpose of the Study:
- To investigate the effect of DAPT versus aspirin alone on overall disability at 90 days in patients with TIA or minor stroke.
- To examine disability specifically attributed by investigators to the index event or recurrent stroke.
- To identify predictors of disability in these patient populations.
Main Methods:
- A post hoc analysis of the POINT trial data was conducted.
- Patients with TIA or minor stroke (NIH Stroke Scale score ≤3) were randomized to DAPT (aspirin plus clopidogrel) or aspirin alone within 12 hours of symptom onset.
- Disability was assessed using the modified Rankin Scale score at 90 days, with specific attention to disability attributed to stroke events.
Main Results:
- Overall disability at 90 days was similar between DAPT and aspirin alone groups (14.7% vs. 14.3%, P=0.69).
- DAPT showed a trend towards fewer patients with disability related to a primary outcome event (3.0% vs. 4.0%, P=0.06).
- Significantly fewer patients in the DAPT arm experienced disability attributed to the index or recurrent stroke (5.9% vs. 7.4%, P=0.04), primarily driven by disability from the index event (4.5% vs. 6.0%, P=0.02).
Conclusions:
- Dual antiplatelet therapy (aspirin plus clopidogrel) may reduce stroke-related disability in patients with acute minor stroke and TIA.
- The reduction in disability appears to be mainly associated with the index stroke event.
- Predictors of disability included age, subsequent ischemic stroke, adverse events, and major bleeding for TIA patients, and sex, hypertension, diabetes, stroke severity, recurrent events, and adverse events for stroke patients.
