Abstract 2743: Effectiveness of Early Dual Antiplatelets in Patients with TIA and Minor Stroke: Post-hoc Analysis of CLAIR Study

Abstract

Background Patients with symptomatic intracranial atherosclerosis are at high risk of early recurrent stroke. Dual antiplatelet therapy appears promising for early secondary prevention of stroke or TIA, yet the ideal patients to benefit from this regime have not been identified. Methods We investigated the efficacy and safety of early dual antiplatelets use in TIA and minor stroke patients (NIHSS 0-3) by performing a post-hoc analysis of CLAIR (Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis) study - a randomized, open-label, blinded-endpoint study in patients who had symptomatic large artery atherosclerosis, in whom micro-embolic signals (MES) were present on transcranial doppler monitoring. MES was used as surrogate marker for recurrent stroke risk. Analysis was by modified intention to treat. Results Sixty-five of 100 patients recruited had TIA or minor stroke (NIHSS 0-3); 30 received dual therapy (aspirin 75-60mg daily and clopidogrel 300mg day 1 then 75mg daily) and 35 received aspirin alone (75-160mg daily) for 7 days. 93% patients had intracranial stenosis. Mean onset-to-randomization was 2.3 days in dual therapy group and 3.2 days in monotherapy group (p=0.03). At day 7, 9 of 29 patients in dual therapy group and 18 of 34 patients in monotherapy group for whom data were available had ≥ 1 MES (relative risk reduction 41.4%, 95% CI 29.8-51.1, p<0.001). The median number of MES on day 7 was 0 in dual therapy group and 1.0 in monotherapy group (p=0.02). Two patients in monotherapy group had recurrent stroke. No patients had intracranial or severe systemic hemorrhage, except two patients in dual therapy group had minor bleeding. Conclusion Early dual therapy with clopidogrel and aspirin reduces MES at day 7 among patients with predominant intracranial atherosclerosis who had minor ischemic stroke or TIA, without causing significant bleeding complications.