title: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  The cohort consisted of 206 patients from 2006 to 2011.
  
  
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.forename: Jinqiu
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China.
authors.forename: Lukui
authors.initials: L
authors.lastname: Chen
authors.forename: Naveen
authors.initials: N
authors.lastname: Chitkara
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000494:pharmacology*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D000077144:Clopidogrel; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000150:complications; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin