Dual antiplatelets reduce microembolic signals in patients with transient ischemic attack and minor stroke: subgroup analysis of CLAIR study.

Abstract

BACKGROUND:

Short course of dual antiplatelet therapy for early secondary prevention is a promising treatment for patients with minor stroke or transient ischemic attack at high risk of recurrence.

METHODS:

We examined the efficacy and safety of dual antiplatelets in patients with transient ischemic attack or minor stroke, defined as National Institute of Health Stroke Scale scores 0-3, in a subgroup analysis of Clopidogrel plus aspirin versus Aspirin alone for Reducing embolization in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR) study. Microembolic signals on transcranial Doppler monitoring was used as surrogate marker for recurrent stroke risk. Patients with ≥1 microembolic signals at baseline were randomized to receive dual therapy (aspirin 75-160 mg daily and clopidogrel 300 mg day 1 then 75 mg daily) or monotherapy (aspirin 75-160 mg daily) for seven-days.

RESULTS:

Sixty-five of 100 patients recruited had transient ischemic attack or minor stroke: 30 received dual therapy and 35 received monotherapy. Mean onset-to-randomization was 2·3 days in dual therapy group and 3·2 days in monotherapy group (P = 0·03). At day 7, the proportion of patients with ≥1 microembolic signals was 9 of 29 patients in dual therapy group and 18 of 34 patients in monotherapy group (adjusted relative risk reduction 41·4%, 95% CI 29·8-51·1, P < 0·001). The median number of microembolic signals on day 7 was 0 in dual therapy group and 1·0 in monotherapy group (P = 0·046). No patients had intracranial or severe systemic hemorrhage.

CONCLUSIONS:

Early dual therapy with clopidogrel and aspirin reduces microembolic signals in patients with minor ischemic stroke or transient ischemic attack, without causing significant bleeding complications.

• Authors: Alexander Y Lau, Yudong Zhao, Christopher Chen, Thomas W Leung, Jianhui Fu, Yining Huang, Nijasri C Suwanwela, Zhao Han, Kay Sin Tan, Disya Ratanakorn, Hugh S Markus, Ka Sing Wong, CLAIR Study Investigators
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 9 Suppl A100 Pg. 127-32 (Oct 2014) ISSN: 1747-4949 [Electronic] United States
• PMID: 23489888 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Adult
• Aged
• Aspirin (therapeutic use)
• Clopidogrel
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Humans
• Intracranial Embolism (diagnostic imaging, drug therapy, etiology)
• Ischemic Attack, Transient (complications)
• Male
• Middle Aged
• Molecular Sequence Data
• Platelet Aggregation Inhibitors (therapeutic use)
• Regression Analysis
• Retrospective Studies
• Severity of Illness Index
• Stroke (complications)
• Ticlopidine (analogs & derivatives, therapeutic use)
• Time Factors
• Ultrasonography, Doppler, Transcranial