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Clopidogrel Con Aspirina en Accidente Cerebral Menor Agudo o Ataque Isquémico Transiente (CHANCE) Ensayo: Resultados

Yilong Wang¹, Yuesong Pan¹, Xingquan Zhao¹

¹From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).

|May 10, 2015

Resumen

El ensayo de Clopidogrel en pacientes de alto riesgo con eventos cerebrovasculares agudos no incapacitantes (CHANCE) demostró que la combinación de clopidogrel y aspirina redujo significativamente el riesgo de accidente cerebrovascular durante un año. Esta doble terapia antiplaquetaria resultó segura, sin aumento en la hemorragia en comparación con la aspirina sola.

Área de la Ciencia:

Neurología Neurología.
Cardiología Cardiología.
Los ensayos clínicos son ensayos clínicos.

Sus antecedentes:

El ensayo de Clopidogrel en pacientes de alto riesgo con eventos cerebrovasculares agudos no incapacitantes (CHANCE) previamente indicó beneficios a corto plazo de la terapia antiplaquetaria dual (clopidogrel-aspirina) sobre la aspirina sola para eventos cerebrovasculares agudos.
Faltaban datos de eficacia y seguridad a largo plazo más allá del período de prueba inicial.

Objetivo del estudio:

Evaluar los resultados del seguimiento de un año del ensayo CHANCE.
Para determinar si los beneficios iniciales del tratamiento con clopidogrel-aspirina persisten más allá de los 90 días.
Evaluar el perfil de seguridad a largo plazo, específicamente con respecto al riesgo de hemorragia.

Principales métodos:

Un ensayo aleatorizado, doble ciego, controlado con placebo que involucró a 5170 pacientes con accidente cerebrovascular leve o ataque isquémico transitorio de alto riesgo.
A los pacientes se les asignó terapia con clopidogrel-aspirina o aspirina sola dentro de las 24 horas posteriores al inicio de los síntomas.
El resultado primario fue la ocurrencia de accidente cerebrovascular (isquémico o hemorrágico) durante un período de seguimiento de 1 año.

Principales resultados:

El accidente cerebrovascular ocurrió en el 10,6% del grupo de clopidogrel-aspirina frente al 14,0% en el grupo de aspirina (HR, 0,78; P = 0,006).
La reducción del riesgo de accidente cerebrovascular en el grupo de terapia dual se mantuvo durante todo el seguimiento de 1 año.
Las tasas de hemorragia moderada o grave fueron bajas y similares entre los grupos (0.3% vs. 0.4%, P=0.44).

Conclusiones:

El beneficio del clopidogrel-aspirina en la reducción del riesgo de accidente cerebrovascular posterior observado en el ensayo CHANCE se mantiene durante al menos 1 año.
La terapia antiplaquetaria dual con clopidogrel y aspirina es una estrategia segura y efectiva para pacientes de alto riesgo después de eventos cerebrovasculares agudos no incapacitantes.
Los hallazgos apoyan el uso extendido de la terapia con clopidogrel-aspirina en esta población de pacientes.

Palabras clave:

clopidogrel y clopidogrel también.ataque isquémico, un ataque transitorio.evaluación del resultado del paciente evaluación del resultado del paciente El golpe del golpe del golpe del golpe del golpe.

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