A Markov model to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin on prevention of recurrent ischemic stroke due to intracranial artery stenosis.

Abstract

BACKGROUND:

Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prognostic prediction could be used to improve decision making.

AIMS:

The aim of the following study is to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin for prevention of recurrent stroke due to atherosclerotic intracranial artery stenosis.

SETTING AND DESIGN:

The cohort consisted of 206 patients from 2006 to 2011.

MATERIALS AND METHODS:

A two-state Markov model was used to predict the prognosis of patients with stroke or transient ischemic attack (TIA) caused by angiographically verified 50-99% stenosis of a major intracranial artery to receive aspirin, clopidogrel, or dual therapy.

STATISTICAL ANALYSIS:

Two tests were used: Pearson Chi-square test or Fisher's exact test (for percentages) and Kruskal Wallis test (for rank order data).

RESULTS:

In the 10-year Markov cohort analysis, 36.24% of patients who were treated with clopidogrel plus aspirin developed to recurrent stroke while the probability for patients in the aspirin group and clopidogrel group was 42.60% and 48.39% respectively. Patients with clopidogrel plus aspirin had the highest quality-adjusted life years, followed by aspirin and clopidogrel.

CONCLUSION:

To prevent recurrent stroke in patients with intracranial artery stenosis, especially in those patients with a history of TIA or coronary artery disease, medical therapy with clopidogrel plus aspirin should be considered in preference to aspirin alone.

• Authors: Jinqiu Yang, Lukui Chen, Naveen Chitkara, Qiang Xu
• Journal: Neurology India (Neurol India) 2014 Jan-Feb Vol. 62 Issue 1 Pg. 48-52 ISSN: 0028-3886 [Print] India
• PMID: 24608454 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Aspirin (pharmacology)
• Brain Ischemia (drug therapy, etiology, prevention & control)
• Clopidogrel
• Cohort Studies
• Constriction, Pathologic (complications)
• Drug Therapy, Combination
• Female
• Humans
• Intracranial Arteriosclerosis (complications)
• Ischemic Attack, Transient (drug therapy, etiology, prevention & control)
• Male
• Markov Chains
• Middle Aged
• Prognosis
• Secondary Prevention
• Stroke (drug therapy, etiology, prevention & control)
• Ticlopidine (analogs & derivatives, pharmacology)
• Time Factors
• Treatment Outcome