RT Journal Article
SR Electronic
T1 Comparative effectiveness of combined antiplatelet treatments in acute minor ischaemic stroke
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 13
OP 21
DO 10.1136/svn-2020-000841
VO 7
IS 1
A1 Kim, Shina
A1 Kim, Joon-Tae
A1 Lee, Ji Sung
A1 Kim, Beom Joon
A1 Park, Jong-Moo
A1 Kang, Kyusik
A1 Lee, Soo Joo
A1 Kim, Jae Guk
A1 Cha, Jae-Kwan
A1 Kim, Dae-Hyun
A1 Park, Tai Hwan
A1 Park, Sang-Soon
A1 Lee, Kyung Bok
A1 Lee, Jun
A1 Hong, Keun-Sik
A1 Cho, Yong-Jin
A1 Park, Hong-Kyun
A1 Lee, Byung-Chul
A1 Yu, Kyung-Ho
A1 Oh, Mi Sun
A1 Kim, Dong-Eog
A1 Ryu, Wi-Sun
A1 Choi, Jay Chol
A1 Kwon, Jee-Hyun
A1 Kim, Wook-Joo
A1 Shin, Dong-Ick
A1 Sohn, Sung-Il
A1 Hong, Jeong-Ho
A1 Park, Man-Seok
A1 Choi, Kang-Ho
A1 Cho, Ki-Hyun
A1 Lee, Juneyoung
A1 Bae, Hee-Joon
YR 2022
UL http://svn.bmj.com/content/7/1/13.abstract
AB Background No study has thoroughly compared the effectiveness of combined antiplatelet treatments (other than clopidogrel–aspirin) versus clopidogrel–aspirin or aspirin alone for early secondary prevention in acute ischaemic stroke.Methods We identified patients with acute, minor, non-cardiogenic ischaemic stroke treated with aspirin alone, clopidogrel–aspirin or other combination treatment. Propensity scores considering the inverse probability of treatment weighting were used to adjust for baseline imbalances. The primary outcome was the composite of all strokes (ischaemic or haemorrhagic), myocardial infarction and all-cause mortality at 3 months.Results Among 12 234 patients (male: 61.9%; age: 65.5±13 years) who met the eligibility criteria, aspirin, clopidogrel–aspirin and other combination treatments were administered in 52.2%, 42.9% and 4.9% of patients, respectively. In the crude analysis, the primary outcome event at 3 months occurred in 14.5% of the other combination group, 14.4% of the aspirin group and 13.0% of the clopidogrel–aspirin group. In the weighted Cox proportional hazards analysis, the 3-month primary outcome event occurred less frequently in the clopidogrel–aspirin group than in the other combination group (weighted HR: 0.82 (0.59–1.13)), while no association was found between the aspirin group (weighted HR: 1.04 (0.76–1.44)) or other combination group and the 3-month primary outcome.Conclusion Other combined antiplatelet treatment, compared with aspirin alone or clopidogrel–aspirin, was not associated with reduced risks of primary composite vascular events or recurrent stroke during the first 3 months after stroke. Therefore, the results suggest that other combination treatments, particularly the cilostazol-based combination, may not be effective alternatives for clopidogrel–aspirin to prevent early vascular events in patients with acute minor stroke. Further exploration in clinical trials will be needed.Data are available upon reasonable request. The CRCS-K research committee will provide the data, analytic methods and study materials to other researchers upon reasonable request.