title: Clopidogrel plus aspirin versus aspirin alone for preventing early neurological deterioration in patients with acute ischemic stroke.
abstract: Recent studies have suggested that combination antiplatelet therapy may be superior to monotherapy in the treatment of acute stroke. However, additional prospective studies are needed to confirm this finding. The present trial compared the efficacy and safety of clopidogrel plus aspirin versus aspirin alone in the treatment of non-cardioembolic ischemic stroke within 72 hours of onset. Six hundred and ninety patients aged ⩾ 40 years with minor stroke or transient ischemic attack (TIA) were identified for enrollment. Experienced physicians determined baseline National Institutes of Health Stroke Scale scores at the time of admission. All patients were randomly allocated (1:1) to receive aspirin alone (300 mg/day) or clopidogrel (300 mg for the first day, 75 mg/day thereafter) plus aspirin (100mg/day). The main endpoints were neurological deterioration, recurrent stroke, and development of stroke in patients with TIA within 14 days of admission. After 43 patients were excluded, 321 patients in the dual therapy group and 326 patients in the monotherapy group completed the treatment. Baseline characteristics were similar between groups. During the 2 week period, stroke deterioration occurred in nine patients in the dual therapy group and 19 patients in the monotherapy group. Stroke occurred after TIA in one patient in the dual therapy group and three patients in the monotherapy group. Similar numbers of adverse events occurred in both groups. This study showed that early dual antiplatelet treatment reduced early neurological deterioration in patients with acute ischemic stroke, compared with antiplatelet monotherapy. These results imply that dual antiplatelet therapy is superior to monotherapy in the early treatment of acute ischemic stroke.
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Fan
authors.initials: F
authors.lastname: He
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Xia
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Jing-Hua
authors.initials: JH
authors.lastname: Zhang
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Xiao-Qiu
authors.initials: XQ
authors.lastname: Li
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Zhong-He
authors.initials: ZH
authors.lastname: Zhou
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Feng-Peng
authors.initials: FP
authors.lastname: Li
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China. Electronic address: chszh@aliyun.com.
authors.forename: Hui-Sheng
authors.initials: HS
authors.lastname: Chen
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000494:pharmacology*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Acute ischemic stroke; Antiplatelet; Deterioration of stroke