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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Treatment Strategies and Prognosis for Moderate Stroke Patients in China
Liyuan Wang1, Qi Zhou2, Hongqiu Gu2
1Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, wlystudent@163.com.
Insights
Dual-antiplatelet therapy (DAPT) in moderate stroke patients did not significantly reduce recurrent stroke risk compared to single antiplatelet therapy. However, DAPT was associated with reduced all-cause mortality at 12 months in this patient group.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Moderate ischemic stroke patients (NIHSS 4-10) without reperfusion therapy are underrepresented in secondary prevention trials.
- Current guidelines lack specific recommendations for antiplatelet strategies in this population.
Purpose of the Study:
- To compare the effectiveness of mono-antiplatelet therapy versus dual-antiplatelet therapy (DAPT) for preventing recurrent stroke.
- To evaluate the impact of DAPT on all-cause mortality in moderate stroke patients.
Main Methods:
- Prospective, nationwide cohort study (Third China National Stroke Registry - CNSR-III).
- Inclusion of moderate ischemic stroke patients (NIHSS 4-10) without IV thrombolysis or endovascular treatment.
- Comparison of outcomes (stroke recurrence, all-cause mortality) between mono- and dual-antiplatelet treatment groups using Cox proportional hazards models.
Main Results:
- No significant difference in stroke recurrence at 3 months (6.6% vs 5.1%) or 12 months (10.7% vs 8.6%) between mono- and DAPT groups.
- DAPT was not significantly associated with reduced mortality at 3 months.
- DAPT significantly reduced all-cause mortality at 12 months (2.3% vs 1.0%, aHR 0.41, p=0.046).
Conclusions:
- In moderate stroke patients, adding clopidogrel to aspirin may not lower recurrent stroke risk compared to single antiplatelet therapy.
- DAPT demonstrated a significant reduction in 12-month all-cause mortality in this cohort.
Introduction:
Moderate stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores of 4-10 and without intravenous thrombolysis or endovascular treatment are basically excluded from current secondary prevention trials. We aimed to explore the effectiveness of mono- versus dual-antiplatelet treatment (DAPT) strategies against subsequent stroke for these patients in a nationwide cohort.
Methods:
Data were derived from the Third China National Stroke Registry (CNSR-III). In this prospective nationwide cohort, moderate ischemic stroke patients with NIHSS scores of 4-10 and without intravenous thrombolysis or endovascular treatment were included and categorized into mono- or dual-antiplatelet groups. Demographics, medical history, NIHSS score, imaging, and laboratory data were collected. The outcomes were stroke recurrence and all-cause mortality at 3 months and 1 year, respectively. Cox proportional hazards models were utilized to investigate the association of treatment strategies and prognosis.
Results:
Of a total of 2,414 patients enrolled in the study, 1,633 (67.6%) received clopidogrel or aspirin, and 781 (32.4%) received DAPT. Recurrent stroke occurred in 108 (6.6%) patients of the mono-antiplatelet group and 40 (5.1%) patients of the DAPT group (adjusted hazard ratio [aHR] 0.73, 95% confidential interval [CI] 0.47-1.13, p = 0.16) at 3 months, and the rate of stroke recurrence was 10.7% in the mono-antiplatelet group and 8.6% in the DAPT group (aHR 0.81, 95% CI 0.58-1.13, p = 0.22) at 12 months. The DAPT paradigm was not significantly associated with death at 3 months (0.6% vs. 0.3%, aHR 0.28, 95% CI: 0.04-2.25) but significantly reduced the mortality at 12 months (2.3% vs. 1.0%, aHR 0.41, 95% CI: 0.17-0.98, p = 0.046).
Conclusions:
In moderate stroke patients presenting within 24 h of symptom onset, the addition of clopidogrel 75 mg to aspirin might not be associated with lower risk of recurrent stroke than aspirin or clopidogrel alone.
