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Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke: A Nationwide, Multicenter Registry-Based Study

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Author(s)
Joon-Tae KimMan-Seok ParkKang-Ho ChoiKi-Hyun ChoBeom Joon KimJong-Moo ParkKyusik KangSoo Joo LeeJae Guk KimJae-Kwan ChaDae-Hyun KimTai Hwan ParkSang-Soon ParkKyung Bok LeeJun LeeKeun-Sik HongYong-Jin ChoHong-Kyun ParkByung-Chul LeeKyung-Ho YuMi Sun OhDong-Eog KimWi-Sun RyuJay Chol ChoiJee-Hyun KwonWook-Joo KimDong-Ick ShinSung Il SohnJeong-Ho HongJi Sung LeeJuneyoung LeeHee-Joon Bae
Keimyung Author(s)
Sohn, Sung IlHong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
Stroke
Issued Date
2019
Volume
50
Issue
11
Keyword
aspirinclopidogrelmyocardial infarctionpropensity scoreproportional hazards models
Abstract
Background and Purpose:
This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke.

Methods:
Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4–15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset.

Results:
Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9% versus 22.6%, P=0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3% versus 20.1%, P=0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4% versus 4.9%, P=0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95% CI, 0.79–1.04) but did reduce the risk of all-cause mortality (0.69; 0.49–0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12–15).

Conclusions:
Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.
Keimyung Author(s)(Kor)
손성일
홍정호
Publisher
School of Medicine (의과대학)
Citation
Joon-Tae Kim et al. (2019). Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke: A Nationwide, Multicenter Registry-Based Study. Stroke, 50(11), 3147–3155. doi: 10.1161/STROKEAHA.119.026044
Type
Article
ISSN
1524-4628
Source
https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.119.026044
DOI
10.1161/STROKEAHA.119.026044
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/42413
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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