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.
| Autor: | Lee HL; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho)., Kim JT; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho)., Lee JS; Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)., Park MS; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho)., Choi KH; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho)., Cho KH; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.-L.L., J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho)., Kim BJ; Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., H.-J.B.)., Park JM; Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea (J.-M.P., K.K.)., Kang K; Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea (J.-M.P., K.K.)., Lee SJ; Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)., Kim JG; Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)., Cha JK; Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)., Kim DH; Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)., Park TH; Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.)., Park SS; Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.)., Lee KB; Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.)., Lee J; Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.)., Hong KS; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)., Cho YJ; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)., Park HK; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)., Lee BC; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)., Yu KH; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)., Sun Oh M; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)., Kim DE; Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)., Ryu WS; Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)., Choi JC; Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Korea (J.C.C.)., Kwon JH; Department of Neurology, Ulsan University College of Medicine, Korea (J.-H.K., W.-J.K.)., Kim WJ; Department of Neurology, Ulsan University College of Medicine, Korea (J.-H.K., W.-J.K.)., Shin DI; Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S.)., Sohn SI; Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)., Hong JH; Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)., Lee J; Department of Biostatistics, Korea University College of Medicine, BK21FOUR Program in Learning Health Systems, Korea University, Seoul (J.L.)., Bae HJ; Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., H.-J.B.). |
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| Jazyk: | angličtina |
| Zdroj: | Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2020 Nov; Vol. 13 (11), pp. e006474. Date of Electronic Publication: 2020 Nov 17. |
| DOI: | 10.1161/CIRCOUTCOMES.119.006474 |
| Abstrakt: | 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 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. |
| Databáze: | MEDLINE |
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