title: Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack.
abstract: BACKGROUND
  The aim of this study was to analyze the benefits and safety associated with the combination therapy of clopidogrel and aspirin among minor stroke or transient ischemic attack patients treated within 12 hours.
  
  
  RESULTS
  This was a subanalysis of the CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events) trial, mainly limited to the prespecified group of patients randomized within 12 hours to either the combination of clopidogrel plus aspirin or aspirin alone. The primary outcome was ischemic stroke during 90-day follow-up. Recurrent ischemic stroke and progressive ischemic stroke were analyzed. Multivariable Cox modeling showed that randomization within 12 hours was an independent predictor of ischemic stroke events (hazard ratio [95% CI] 1.25 [1.04-1.49], P=0.02). Among 2573 patients randomized within 12 hours, 282 (10.96%) patients had ischemic stroke events. Among them, 158 (12.34%) of 1280 patients taking aspirin experienced ischemic stroke compared with 124 (9.59%) of 1293 patients taking clopidogrel-aspirin (P=0.02). The dual antiplatelet was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke (6.57% versus 8.91%, P=0.03) but not progressive ischemic stroke (3.02% versus 3.43%, P=0.28). There was no significant difference in hemorrhagic events (P=0.39).
  
  
  CONCLUSIONS
  Among patients treated within 12 hours, the combination of clopidogrel and aspirin was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke during the 90-day follow-up and did not increase the hemorrhagic risk.
  
  
  BACKGROUND
  URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00979589.
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China China National Clinical Research Center for Neurological Diseases, Beijing, China.
authors.forename: Zixiao
authors.initials: Z
authors.lastname: Li
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China China National Clinical Research Center for Neurological Diseases, Beijing, China yongjunwang1962@gmail.com yilong528@gmail.com yilong528@gmail.com.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Neuro-intensive Care Unit, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: Illinois Neurological, Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria, IL.
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xianwei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Chunjuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Yang
authors.affiliation: Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Jing
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: Departments of Neurology and Epidemiology, University of California, San Francisco, CA.
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.affiliation: Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China yongjunwang1962@gmail.com yilong528@gmail.com yilong528@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D002681:China; D000077144:Clopidogrel; D018450:Disease Progression; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: acute cerebral infarction; antiplatelets; transient ischemic attacks; trials