title: Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year Outcomes.
abstract: BACKGROUND
  The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial showed that the combined treatment of clopidogrel and aspirin decreases the 90-day risk of stroke without increasing hemorrhage in comparison with aspirin alone, but provided insufficient data to establish whether the benefit persisted over a longer period of time beyond the trial termination. We report the 1-year follow-up outcomes of this trial.
  
  
  RESULTS
  The trial was a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China. We randomly assigned 5170 patients within 24 hours after onset of minor stroke or high-risk transient ischemic attack to clopidogrel-aspirin therapy (loading dose of 300 mg of clopidogrel on day 1, followed by 75 mg of clopidogrel per day for 90 days, plus 75 mg of aspirin per day for the first 21 days) or to the aspirin-alone group (75 mg/d for 90 days). The primary outcome was stroke event (ischemic or hemorrhagic) during 1-year follow-up. Differences in outcomes between groups were assessed by using the Cox proportional hazards model. Stroke occurred in 275 (10.6%) patients in the clopidogrel-aspirin group, in comparison with 362 (14.0%) patients in the aspirin group (hazard ratio, 0.78; 95% confidence interval, 0.65-0.93; P=0.006). Moderate or severe hemorrhage occurred in 7 (0.3%) patients in the clopidogrel-aspirin group and in 9 (0.4%) patients in the aspirin group (P=0.44).
  
  
  CONCLUSIONS
  The early benefit of clopidogrel-aspirin treatment in reducing the risk of subsequent stroke persisted for the duration of 1-year of follow-up.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Anxin
authors.initials: A
authors.lastname: Wang
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.).
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: From Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yilong Wang, Y.P., X.Z., H.L., LL., X.M., A.W., C.W., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Dell Medical School, University of Texas at Austin (S.C.J.). yongjunwang1962@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: clopidogrel; ischemic attack, transient; patient outcome assessment; stroke