Kombinasi terapi colipodgrel dan aspirin dibandingkan aspirin saja pada pasien stroke minor dan TIA

8/10/2019 Kombinasi terapi colipodgrel dan aspirin dibandingkan aspirin saja pada pasien stroke minor dan TIA

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Yongjun Wang, M.D., Yilong Wang, M.D., Ph.D., Xingquan Zhao, M.D., Ph.D., LipingLiu, M.D., Ph.D., David Wang, D.O., F.A.H.A., F.A.A.N., Chunxu Wang, M.D., Ph.D.,

Chn Wang, M.D., Hao Li, Ph.D., Xia Mng, M.D., Ph.D., Li!ing Cui, M.D., Ph.D.,"ianping "ia, M.D., Ph.D., #iang Dong, M.D., Ph.D., Anding Xu, M.D., Ph.D.,

"in$hng Zng, M.D., Ph.D., Yan$hng Li, M.D., Ph.D., Zhi%in Wang, M.D., HaiqinXia, M.D., &. Clai'o(n "ohn$)on, M.D., Ph.D., *o( )h CHANC+ nv$)iga)o($

N +ngl " Md-olu% /0123422520

"ul! 6, 782

Original ArticleClopidogrel with Aspirin in Acute Minor Stroke or

Transient Ischemic Attack


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9 Transient ischemic attack (TIA) and acute minor ischemic stroke arecommon and often lead to disabling events.

9 The risk of another stroke occurring after a TIA or minor stroke is high,with approximately ! to "!# of patients having a stroke within $

months after the index event% most of these strokes occur within the

first " days.

Background


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9 The role of antiplatelet therapy for secondary stroke prevention hasbeen well established.

9 &owever, aspirin is the only antiplatelet agent that has been studied inthe acute phase of stroke, during which its benefit is modest.

9 Aspirin and clopidogrel synergistically inhibit platelet aggregation,

Background


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Hypothesis

9 $ months of treatment with a combination of clopidogrel and aspirinwould reduce the risk of recurrent stroke, as compared with aspirin

alone, among patients with acute high'risk TIA or minor ischemic

stroke.


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Methods

9 The trial was designed by three of the authors and was overseen by theexecutive committee

9 ata collection and entry were performed by staff at the Tiantan

linical Trial and *esearch enter for +troke, where the data analysis

was performed

9 There was no confidentiality agreement between the study sponsor (the

inistry of +cience and Technology of the -eoples *epublic of hina)

and the investigators


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Methods

9 All the participants or their legal proxies provided written informed consent.

9 The &A/0 (lopidogrel in &igh'*isk -atients with Acute /ondisablingerebrovascular 0vents) trial protocol was approved by the ethics committee at

each study center.


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Study population

Inclusion criteria


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0xclusion riteria


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Study design

9 &A/0 was a randomi1ed, double'blind, placebo' controlled clinical trialconducted at 2 clinical centers in hina


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Study design


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Study outcome

9 The primary efficacy outcome was a new stroke event (ischemic orhemorrhagic) at 3! days.

9 The primary safety outcome was a moderateto' severe bleeding event,according to the 4lobal 5tili1ation of +treptokinase and Tissue -lasminogen

Activator for 6ccluded oronary Arteries (45+T6) definition

9 7ey secondary efficacy outcomes included a new clinical vascular event(ischemic stroke, hemorrhagic stroke, myocardial infarction, or vascular death)


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Result


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Baseline Characteristics of the Patients.

Wang et al. ! "ngl # Med$%&'(')*+&&,&*


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"fficac- and Safet- Outcomes.

Wang et al. ! "ngl # Med $%&'(')*+&&,&*


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a/ard 0atio for the Primar- Outcome in Prespecified Su1groups.

Wang et al. ! "ngl # Med $%&'(')*+&&,&*


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Disscusion

9 The results of our trial differ from those of other trials of combinationtherapy with clopidogrel and aspirin after cerebral ischemic events.

6ne possible explanation is that, unlike previous trials, our trial

targeted a population at particularly high risk for recurrent ischemia and

at low risk for hemorrhage


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9 In our study, the curves for survival free of stroke were particularlysteep in the first fewdays, during which the curves representing the

treatment groups diverged dramatically. +ubse8uently, the rates of

stroke were similar.


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Pro1a1ilit- of Sur2i2al 3ree of Stroke.

Wang et al. ! "ngl # Med $%&'(')*+&&,&*


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Conclusions

9 A%ong pa)in)$ :i)h ;A o( %ino( $)(o


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Kombinasi terapi colipodgrel dan aspirin dibandingkan aspirin saja pada pasien stroke minor dan TIA