Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Mild-to-Moderate Acute Ischemic Stroke According to the Risk of Recurrent Stroke: An Analysis of 15 000 Patients From a Nationwide, Multicenter Registry.

Abstract

BACKGROUND:

This study compared the effectiveness of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin with that of aspirin monotherapy (AM) in mild-to-moderate acute ischemic stroke considering the risk of recurrent stroke using the Stroke Prognosis Instrument II (SPI-II) score.

METHODS:

This study is a retrospective analysis of data from a prospective, nationwide, multicenter stroke registry database between January 2011 and July 2018. We included patients with mild-to-moderate (National Institutes of Health Stroke Scale score ≤10), acute (within 24 hours of onset), noncardioembolic ischemic stroke. The primary outcome was a 3-month composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality. Propensity scores using the inverse probability of treatment weighting method were used to mitigate baseline imbalances between the DAPT and AM groups and within each subgroup considering SPI-II scores.

RESULTS:

Among the 15 430 patients (age, 66±13 years; men, 62.0%), 45.1% (n=6960) received DAPT and 54.9% (n=8470) received AM. Primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%; P=0.03). Weighted Cox proportional hazards models showed a reduced risk of 3-month primary vascular events in the DAPT group versus the AM group (hazard ratio, 0.84 [0.78-0.92]; P<0.001), with no interaction between acute treatment type and SPI-II risk subgroups (Pinteraction=0.44). However, among the high-risk patients with SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group (weighted absolute risk differences, 5.4%), whereas smaller absolute benefits were observed among patients in the low- or medium-risk SPI-II subgroups (1.7% and 2.4%, respectively).

CONCLUSIONS:

Treatment with clopidogrel-aspirin was associated with a reduction in 3-month vascular events compared with AM in mild-to-moderate acute noncardioembolic ischemic stroke patients. Larger magnitudes of the effects of DAPT with clopidogrel-aspirin were observed in the high-risk subgroup by SPI-II risk scores.

• Authors: Hak-Loh Lee, Joon-Tae Kim, Ji Sung Lee, Man-Seok Park, Kang-Ho Choi, Ki-Hyun Cho, Beom Joon Kim, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Tai Hwan Park, Sang-Soon Park, Kyung Bok Lee, Jun Lee, Keun-Sik Hong, Yong-Jin Cho, Hong-Kyun Park, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Dong-Eog Kim, Wi-Sun Ryu, Jay Chol Choi, Jee-Hyun Kwon, Wook-Joo Kim, Dong-Ick Shin, Sung Il Sohn, Jeong-Ho Hong, Juneyoung Lee, Hee-Joon Bae
• Journal: Circulation. Cardiovascular quality and outcomes (Circ Cardiovasc Qual Outcomes) Vol. 13 Issue 11 Pg. e006474 (11 2020) ISSN: 1941-7705 [Electronic] United States
• PMID: 33201737 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Aspirin

Topics

• Aged
• Aspirin (adverse effects, therapeutic use)
• Clopidogrel (adverse effects, therapeutic use)
• Comparative Effectiveness Research
• Databases, Factual
• Dual Anti-Platelet Therapy (adverse effects, mortality)
• Female
• Hemorrhagic Stroke (mortality, prevention & control)
• Humans
• Ischemic Stroke (diagnosis, drug therapy, mortality)
• Male
• Middle Aged
• Myocardial Infarction (mortality, prevention & control)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Recurrence
• Registries
• Republic of Korea (epidemiology)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome