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Dual Antiplatelet Therapy and Outcomes in Acute Mild to Moderate Stroke With Versus Without Large-Artery
Yu Cui1, Quan-Ying Liu1, Hui-Sheng Chen1
1Department of Neurology General Hospital of Northern Theater Command Shenyang China.
Insights
Dual antiplatelet therapy with clopidogrel plus aspirin significantly reduced early neurologic deterioration in patients with large-artery atherosclerosis stroke. This benefit was not observed in the non-large-artery atherosclerosis stroke subtype.
Area of Science:
- Neurology
- Cardiology
- Clinical Trials
Background:
- A post hoc analysis of the ATAMIS trial investigated dual antiplatelet therapy (clopidogrel plus aspirin) versus aspirin alone.
- The study focused on stroke patients with and without large-artery atherosclerosis (LAA) pathogenesis.
Purpose of the Study:
- To determine if the efficacy of clopidogrel plus aspirin over aspirin alone differs between LAA and non-LAA stroke subtypes.
- To assess treatment effects on early neurologic deterioration and safety outcomes.
Main Methods:
- A modified intention-to-treat analysis of 2910 ATAMIS trial participants.
- Patients were classified into LAA (225) and non-LAA (2685) subtypes.
- Primary outcome: early neurologic deterioration at 7 days; secondary outcomes: bleeding and intracranial hemorrhage.
Main Results:
- Dual antiplatelet therapy significantly reduced early neurologic deterioration in the LAA subtype (adjusted risk difference: -10.4%).
- No significant reduction in early neurologic deterioration was observed in the non-LAA subtype (adjusted risk difference: -1.4%).
- No significant interaction between treatment and stroke subtype was found (P=0.11).
Conclusions:
- Patients with LAA stroke may benefit more from dual antiplatelet therapy (clopidogrel plus aspirin) compared to aspirin alone.
- The findings suggest a potential differential benefit of dual antiplatelet therapy based on stroke etiology.
Background:
We conducted a post hoc analysis of the ATAMIS (Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke) trial to investigate whether the priority of clopidogrel plus aspirin to aspirin alone was consistent between patients with and without stroke pathogenesis of large-artery atherosclerosis (LAA).
Methods And Results:
Patients with stroke classification randomized to a clopidogrel-plus-aspirin group and aspirin-alone group in a modified intention-to-treat analysis set of ATAMIS were classified into LAA and non-LAA subtypes. The primary outcome was early neurologic deterioration at 7 days, defined as a >2-point increase in National Institutes of Health Stroke Scale score compared with baseline, and safety outcomes were bleeding events and intracranial hemorrhage. We compared treatment effects in each stroke subtype and investigated the interaction. Among 2910 patients, 225 were assigned into the LAA subtype (119 in the clopidogrel-plus-aspirin group and 106 in the aspirin-alone group) and 2685 into the non-LAA subtype (1380 in the clopidogrel-plus-aspirin group and 1305 in the aspirin-alone group). Median age was 66 years, and 35% were women. A lower proportion of early neurologic deterioration was found to be associated with dual antiplatelet therapy in the LAA subtype (adjusted risk difference, -10.4% [95% CI, -16.2% to -4.7%]; P=0.001) but not in the non-LAA subtype (adjusted risk difference, -1.4% [95% CI, -2.6% to 0.1%]; P=0.06). No significant interaction was found (P=0.11).
Conclusions:
Compared with the non-LAA subtype, patients with stroke of the LAA subtype may get more benefit from dual antiplatelet therapy with clopidogrel plus aspirin with respect to early neurologic deterioration at 7 days.
Registration:
URL: clinicaltrials.gov; UnIque identifier: NCT02869009.
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