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-Loh; Kim, Joon-Tae; Lee, Ji Sung; Park, Man-Seok; Choi, Kang-Ho; Cho, Ki-Hyun; Kim, Beom Joon; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi Sun; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Kwon, Lee-Hyun; Kim, Wook-Joo; Shin, Dong-Ick; Sohn, Sung Il; Hong, Jeong-Ho; Lee, Juneyoung; Bae, Hee-Joon
- Issue Date
- 11월-2020
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- aspirin; clopidogrel; prognosis; prospective studies; registries
- Citation
- CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, v.13, no.11
- Indexed
- SCIE
SCOPUS
- Journal Title
- CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
- Volume
- 13
- Number
- 11
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/52084
- DOI
- 10.1161/CIRCOUTCOMES.119.006474
- ISSN
- 1941-7713
- 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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