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Cited 11 time in webofscience Cited 9 time in scopus
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Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Mild-to-Moderate Acute Ischemic Stroke According to the Risk of Recurrent Stroke An Analysis of 15 000 Patients From a Nationwide, Multicenter Registry

Authors
Lee, Hak-LohKim, Joon-TaeLee, Ji SungPark, Man-SeokChoi, Kang-HoCho, Ki-HyunKim, Beom JoonPark, Jong-MooKang, KyusikLee, Soo JooKim, Jae GukCha, Jae-KwanKim, Dae-HyunPark, Tai HwanPark, Sang-SoonLee, Kyung BokLee, JunHong, Keun-SikCho, Yong-JinPark, Hong-KyunLee, Byung-ChulYu, Kyung-HoOh, Mi SunKim, Dong-EogRyu, Wi-SunChoi, Jay CholKwon, Lee-HyunKim, Wook-JooShin, Dong-IckSohn, Sung IlHong, Jeong-HoLee, JuneyoungBae, Hee-Joon
Issue Date
Nov-2020
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
aspirin; clopidogrel; prognosis; prospective studies; registries
Citation
Circulation. Cardiovascular quality and outcomes, v.13, no.11, pp 853 - 863
Pages
11
Indexed
SCIE
SCOPUS
Journal Title
Circulation. Cardiovascular quality and outcomes
Volume
13
Number
11
Start Page
853
End Page
863
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/51844
DOI
10.1161/CIRCOUTCOMES.119.006474
ISSN
1941-7713
1941-7705
Abstract
Background: This study compared the effectiveness of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin with that of aspirin monotherapy (AM) in mild-to-moderate acute ischemic stroke considering the risk of recurrent stroke using the Stroke Prognosis Instrument II (SPI-II) score. Methods: This study is a retrospective analysis of data from a prospective, nationwide, multicenter stroke registry database between January 2011 and July 2018. We included patients with mild-to-moderate (National Institutes of Health Stroke Scale score <= 10), acute (within 24 hours of onset), noncardioembolic ischemic stroke. The primary outcome was a 3-month composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality. Propensity scores using the inverse probability of treatment weighting method were used to mitigate baseline imbalances between the DAPT and AM groups and within each subgroup considering SPI-II scores. Results: Among the 15 430 patients (age, 66 +/- 13 years; men, 62.0%), 45.1% (n=6960) received DAPT and 54.9% (n=8470) received AM. Primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%; P=0.03). Weighted Cox proportional hazards models showed a reduced risk of 3-month primary vascular events in the DAPT group versus the AM group (hazard ratio, 0.84 [0.78-0.92]; P<0.001), with no interaction between acute treatment type and SPI-II risk subgroups (P-interaction=0.44). However, among the high-risk patients with SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group (weighted absolute risk differences, 5.4%), whereas smaller absolute benefits were observed among patients in the low- or medium-risk SPI-II subgroups (1.7% and 2.4%, respectively). Conclusions: Treatment with clopidogrel-aspirin was associated with a reduction in 3-month vascular events compared with AM in mild-to-moderate acute noncardioembolic ischemic stroke patients. Larger magnitudes of the effects of DAPT with clopidogrel-aspirin were observed in the high-risk subgroup by SPI-II risk scores.
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