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Updated: Sep 30, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Dual versus mono antiplatelet therapy in mild-to-moderate stroke during hospitalization
Haimei Fan1,2, Yongle Wang1, Tingting Liu1
1Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China.
Insights
Combination therapy with clopidogrel and aspirin significantly reduced vascular events in mild-to-moderate ischemic stroke patients. This dual antiplatelet therapy, combined with high-intensity statins, proved effective and safe during hospitalization.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Pharmacy
Background:
- Subsequent vascular events pose a significant risk for patients hospitalized with acute ischemic stroke.
- Early intervention is crucial to mitigate these risks and improve patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of combination therapy with clopidogrel and aspirin in patients with mild-to-moderate ischemic stroke.
- To assess this therapy's impact when administered within 72 hours of symptom onset, alongside high-intensity statin treatment.
Main Methods:
- A retrospective, multicenter cohort study design was employed.
- Patients with acute mild-to-moderate ischemic stroke received either aspirin alone or a combination of clopidogrel and aspirin, all on high-intensity statin therapy.
- Cox proportional hazards models were utilized to analyze the primary outcome of compound vascular events during hospitalization.
Main Results:
- The clopidogrel-aspirin group showed a significantly lower incidence of compound vascular events (7.2%) compared to the aspirin-only group (13.7%).
- Cox regression analysis revealed that clopidogrel-aspirin was associated with a reduced risk of compound vascular events (HR, 0.47; 95% CI, 0.25-0.87) and ischemic vascular events.
- The incidence of moderate to severe hemorrhage was similar between the two groups, indicating no increased bleeding risk with combination therapy.
Conclusions:
- Combination therapy with clopidogrel and aspirin, when used with high-intensity statins, effectively reduces the risk of vascular events in hospitalized patients with mild-to-moderate ischemic stroke.
- This treatment strategy is safe, as it does not increase the risk of hemorrhage during the hospitalization period.
Objective:
Subsequent vascular events are common after acute ischemic stroke during hospitalization. This study aimed to analyze the effectiveness of combination therapy with clopidogrel and aspirin among mild-to-moderate ischemic stroke patients treated within 72 h on the basis of a high-intensity dose of statins.
Methods:
In a retrospective and multicenter cohort study, acute (within 72 h of onset) mild-to-moderate stroke patients were divided into aspirin and clopidogrel-aspirin groups on the basis of a high-intensity dose of statin therapy. The primary outcome was compound vascular events during hospitalization. Cox's proportional hazards model was used to assess differences, with the study center as a random effect.
Results:
Among the 506 patients meeting the eligibility criteria, all subjects received a high-intensity dose of statins, including 20 mg rosuvastatin or 40 mg atorvastatin while in the hospital. In an unadjusted analysis, compound vascular events occurred in 7.2% of patients in the clopidogrel-aspirin group compared with 13.7% of those in the aspirin group (p = 0.022). In a Cox proportional hazards regression analysis, clopidogrel-aspirin was associated with a lower risk of compound vascular events (hazard ratio [95% CI], 0.47 [0.25-0.87]; p = 0.017) and ischemic vascular events (p = 0.008). Moderate and severe hemorrhage occurred in four patients (1.07%) in the clopidogrel-aspirin group and three patients (2.30%) in the aspirin group (p = 0.626).
Interpretation:
In this study based on high-intensity statin therapy, clopidogrel-aspirin reduced the risk of compound vascular events and did not increase the risk of hemorrhage during patients' hospitalization after mild-to-moderate ischemic stroke within 72 h.
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