Clopidogrel and Aspirin Initiated Between 24 to 72 Hours for Mild Ischemic Stroke: A Subgroup Analysis of the INSPIRES Randomized Clinical Trial
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View abstract on PubMed
Summary
This summary is machine-generated.Dual antiplatelet therapy with clopidogrel and aspirin effectively reduces the risk of new stroke in patients with mild ischemic stroke or transient ischemic attack (TIA) within 72 hours of symptom onset, with similar bleeding risks compared to aspirin alone.
Area Of Science
- Neurology
- Cardiology
- Clinical Trials
Background
- Dual antiplatelet therapy (DAPT) reduces early stroke risk in acute mild ischemic stroke or TIA within 24 hours.
- Efficacy of DAPT beyond 24 hours remains uncertain.
Purpose Of The Study
- To evaluate DAPT (clopidogrel-aspirin) vs. aspirin alone for mild ischemic stroke/TIA.
- Assess efficacy and safety across different initiation time windows: ≤24 hours, >24-48 hours, and >48-72 hours.
Main Methods
- Double-blind, placebo-controlled, multicenter randomized clinical trial (NCT03635749) in China.
- 6100 patients with mild ischemic stroke/TIA randomized to clopidogrel-aspirin or aspirin alone within 72 hours.
- Follow-up for 90 days, primary outcome: new stroke; safety outcome: moderate-to-severe bleeding.
Main Results
- DAPT showed a trend towards reduced new stroke risk across all time windows compared to aspirin alone.
- For >48-72 hours: 5.8% vs. 8.2% stroke risk (HR 0.70).
- For >24-48 hours: 7.6% vs. 8.9% (HR 0.85).
- For ≤24 hours: 11.5% vs. 13.4% (HR 0.83).
- No significant interaction for stroke risk across time windows (P=.38).
- Bleeding risk was similar between groups across all time windows (P=.92 for interaction).
Conclusions
- DAPT with clopidogrel and aspirin provides consistent benefit in reducing new stroke risk within 72 hours of symptom onset for mild ischemic stroke/TIA patients.
- The increase in bleeding risk with DAPT was comparable to aspirin alone.
- DAPT is recommended within 72 hours for these patients.
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