Abstract
The study aimed to evaluate whether the benefits of dual antiplatelet therapy would be influenced by blood pressure (BP) levels, among acute minor stroke or transient ischemic attack (TIA). In CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling cerebrovascular Events) trail, Patients were stratified by systolic BP (SBP) and diastolic BP (DBP) level measured on admission, respectively, using the supine position BP within 24 hours after symptoms onset. The primary efficacy outcome was stroke recurrence, bleeding was the safety outcome. Patients with SBP ≥ 140 mmHg, dual antiplatelet treatment could reduce the risk of stroke recurrence significantly (HR 0.654, 95% CI 0.529–0.793, p < 0.001) than mono antiplatelet therapy. And patients with DBP ≥ 90 mmHg, clopidogrel-aspirin significantly reduced the risk of recurrent stroke (HR 0.588, 95% CI 0.463–0.746, p < 0.001), compared with aspirin alone. However, in patients with SBP < 140 mmHg or DBP < 90 mmHg, no significant difference was observed between clopidogrel plus aspirin and aspirin alone. there was no difference in bleeding episodes by treatment assignment across categories of SBP or DBP. Patients with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg after minor stroke or TIA got more benefits from dual antiplatelet therapy. Bleeding risk from dual antiplatelet treatment did not increase among patients with higher BP level on admission.
Highlights
Minor ischemic stroke and transient ischemic attack (TIA) patients are at high risk of recurrent stroke from 12% to 20% during the first 3 months after the index stroke or TIA1–3
There was no significant difference of bleeding event rate between dual and mono antiplatelet treatment, either in systolic BP (SBP) or diastolic BP (DBP) subgroup (Table 2 and 3). In this post-hoc analysis of the CHANCE trial, we found that patients with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg got more benefits from dual antiplatelet therapy on stroke recurrence and CVD than patients with SBP < 140 mmHg or DBP < 90 mmHg
Clopidogrel plus aspirin did not increase the risk of bleeding in patients with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg
Summary
Minor ischemic stroke and transient ischemic attack (TIA) patients are at high risk of recurrent stroke from 12% to 20% during the first 3 months after the index stroke or TIA1–3. The Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial found that dual antiplatelet therapy (clopidogrel plus aspirin) within 24 hours after symptom onset could reduce the risk of subsequent stroke by 32.0%, as compared with aspirin alone[4]. The Secondary Prevention of Small Subcortical Strokes (SPS3) trial support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure (SBP) target of less than 130 mm Hg is likely to be beneficial[7]. No studies had focused on whether these 2 intervention strategies have interaction on stroke outcomes In this subgroup analysis of the Clopidogrel in High-Risk Patients with Acute Nondisabling cerebrovascular Events (CHANCE) trail, we aimed to investigate whether there was interaction between BP (SBP and DBP) level and antiplatelet therapy on stroke recurrence among patients with minor stroke and high-risk TIA
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