Dual antiplatelet therapy in stroke and ICAS
Subgroup analysis of CHANCE
Abstract
Objective:
We aimed to investigate whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone were consistent between patients with and without intracranial arterial stenosis (ICAS), in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.
Methods:
We assessed the interaction of the treatment effects of the 2 antiplatelet therapies among patients with and without ICAS, identified by magnetic resonance angiography (MRA) in CHANCE (ClinicalTrials.gov identifier NCT00979589).
Results:
Overall, 1,089 patients with MRA images available in CHANCE were included in this subanalysis, 608 patients (55.8%) with ICAS and 481 (44.2%) without. Patients with ICAS had higher rates of recurrent stroke (12.5% vs 5.4%; p < 0.0001) at 90 days than those without. But there was no statistically significant treatment by presence of ICAS interaction on either the primary outcome of any stroke (hazard ratio for clopidogrel plus aspirin vs aspirin alone: 0.79 [0.47–1.32] vs 1.12 [0.56–2.25]; interaction p = 0.522) or the safety outcome of any bleeding event (interaction p = 0.277).
Conclusions:
The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial.
Classification of evidence:
This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
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Information & Authors
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Copyright
© 2015 American Academy of Neurology.
Publication History
Received: February 3, 2015
Accepted: June 3, 2015
Published online: August 28, 2015
Published in print: September 29, 2015
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
Supported by grants 2008ZX09312-008, 2011BAI08B02, 2012ZX09303, and 200902004 from the Ministry of Science and Technology, China; and the Chinese University of Hong Kong (Focused Investment Scheme B) and the Institute of Innovative Medicine, Chinese University of Hong Kong, China.
Authors
Author Contributions
Dr. Liping Liu and Dr. Ka Sing Lawrence Wong contributed to study design, literature search, data analysis, data interpretation, and manuscript preparation. Dr. Xinyi Leng contributed to literature search, data analysis and interpretation, figures, and manuscript preparation. Dr. Yuehua Pu contributed to data collection and interpretation and manuscript preparation. Dr. Yilong Wang contributed to study design and data interpretation, and provided critical and essential comments on the manuscript. Dr. Jing Jing and Dr. Xinying Zou contributed to data collection and image analysis and interpretation. Dr. Yuesong Pan and Mr. Anxin Wang contributed to statistical analysis, data interpretation, and figures. Dr. Xia Meng contributed to data collection and image interpretation. Dr. Chunxue Wang, Dr. Xingquan Zhao, and Dr. Yannie Soo contributed to study design and provided critical and essential comments on the manuscript. Dr. S. Claiborne Johnston and Dr. Yongjun Wang were the principal investigators of the CHANCE study, and contributed to study design, data analysis and interpretation, and provided critical comments on the manuscript.
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