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Effectiveness and Safety of Clopidogrel vs Aspirin in Elderly Patients With Ischemic Stroke
Hsin-Yi Huang1, Shin-Yi Lin2, Aaron J Katz3
1School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
Insights
For elderly patients (80+) with acute ischemic stroke, clopidogrel use significantly reduced the risk of recurrent stroke and major bleeding events compared to aspirin. This finding supports clopidogrel as a potentially safer alternative for stroke prevention in this population.
Area of Science:
- Cardiovascular Medicine
- Geriatric Medicine
- Pharmacology
Background:
- Elderly patients (80+ years) with acute ischemic stroke face high risks of recurrent events and bleeding complications.
- Dual antiplatelet therapy is common, but optimal monotherapy choice between clopidogrel and aspirin in this age group requires further evaluation.
- Understanding comparative risks is crucial for guiding clinical decisions in stroke management for the elderly.
Purpose of the Study:
- To compare the risks of recurrent stroke and major bleeding events between clopidogrel and aspirin monotherapy in patients aged 80 years or older.
- To evaluate the safety and efficacy of clopidogrel versus aspirin in preventing secondary cardiovascular events in elderly stroke survivors.
Main Methods:
- Retrospective cohort study utilizing Taiwan's Health and Welfare Database (2009-2018).
- Included 15,045 patients aged 80+ hospitalized for primary acute ischemic stroke, receiving either clopidogrel or aspirin monotherapy.
- Inverse probability of treatment weighting (IPTW) applied to balance covariates; outcomes included recurrent stroke, MI, and major bleeding events.
Main Results:
- Clopidogrel use was associated with a significantly lower risk of recurrent acute ischemic stroke (HR 0.89) compared to aspirin.
- Clopidogrel also showed reduced risks for composite cardiovascular events (HR 0.88) and intracranial hemorrhage (HR 0.71).
- Significantly lower risk of composite major bleeding events (HR 0.89) was observed with clopidogrel compared to aspirin.
Conclusions:
- In elderly patients (80+) with primary acute ischemic stroke, clopidogrel monotherapy demonstrated lower risks of recurrent stroke and cardiovascular events versus aspirin.
- Clopidogrel use was also associated with reduced risks of intracranial hemorrhage and overall major bleeding events.
- These findings suggest clopidogrel may be a preferable antiplatelet agent for stroke prevention in the very elderly.
Objective:
To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older.
Patients And Methods:
This retrospective cohort study was conducted using the Full Population Data of the Health and Welfare Database in Taiwan. Patients aged 80 years or older who received monotherapy with clopidogrel or aspirin following hospitalization for primary acute ischemic stroke between January 1, 2009, and December 31, 2018, were included. Inverse probability of treatment weighting was used to balance measured covariates between clopidogrel and aspirin users. Measured outcomes included recurrent acute ischemic stroke, acute myocardial infarction, composite cardiovascular events (recurrent stroke or acute myocardial infarction), intracranial hemorrhage, major gastrointestinal tract bleeding, and composite major bleeding events (intracranial hemorrhage or major gastrointestinal tract bleeding).
Results:
A total of 15,045 patients were included in the study, 1979 of whom used clopidogrel and 13,066 who used aspirin following hospitalization for primary acute ischemic stroke. Clopidogrel use was associated with significantly lower risk of recurrent acute ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.83 to 0.96; P=.002), composite cardiovascular events (HR, 0.88; 95% CI, 0.82 to 0.95; P<.001), intracranial hemorrhage (HR, 0.71; 95% CI, 0.56 to 0.90; P=.005), and composite major bleeding events (HR, 0.89; 95% CI, 0.80 to 0.99; P=.04) compared with aspirin use.
Conclusion:
In patients aged 80 years or older with primary acute ischemic stroke, clopidogrel users had lower risks of recurrent stroke and the composite cardiovascular events compared with aspirin users. Clopidogrel users also had lower risks of intracranial hemorrhage and the composite major bleeding events compared with aspirin users.
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