RT Journal Article
SR Electronic
T1 Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 541
OP 550
DO 10.1136/svn-2023-002450
VO 9
IS 5
A1 Zhang, Xinmiao
A1 Jing, Jing
A1 Wang, Anxin
A1 Xie, Xuewei
A1 Johnston, S Claiborne
A1 Li, Hao
A1 Bath, Philip M
A1 Xu, Qin
A1 Lin, Jinxi
A1 Wang, Yilong
A1 Zhao, Xingquan
A1 Li, Zixiao
A1 Jiang, Yong
A1 Liu, Liping
A1 Chen, Weifeng
A1 Gong, Xuhai
A1 Li, Jianhua
A1 Han, Xinsheng
A1 Meng, Xia
A1 Wang, Yongjun
YR 2024
UL http://svn.bmj.com/content/9/5/541.abstract
AB Objectives Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited, especially those elder than 80 years. This study aimed to explore the efficacy and safety of dual antiplatelet therapy (DAPT) in old-old patients compared with younger patients in the ticagrelor or Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events-II (CHANCE-2) trial.Methods CHANCE-2 was a randomised, double-blind, placebo-controlled trial in China involving patients with high-risk transient ischaemic attack or minor stroke with CYP2C19 loss-of-function alleles. In our substudy, all enrolled patients were stratified by age: old-old (≥80 years), young-old (65–80 years) and younger (<65 years). The primary outcomes were stroke recurrence and moderate to severe bleeding within 90 days, respectively.Results Of all the 6412 patients, 406 (6.3%) were old-old, 2755 (43.0%) were young-old and 3251 (50.7%) were younger. Old-old patients were associated with higher composite vascular events (HR 1.41, 95% CI 1.00 to 1.98, p=0.048), disabling stroke (OR 2.43, 95% CI 1.52 to 3.88, p=0.0002), severe or moderate bleeding (HR 8.40, 95% CI 1.95 to 36.21, p=0.004) and mortality (HR 7.56, 95% CI 2.23 to 25.70, p=0.001) within 90 days. Ticagrelor-aspirin group was associated with lower risks of stroke recurrence within 90 days in younger patients (HR 0.68, 95% CI 0.51 to 0.91, p=0.008), which was no differences in old-old patients.Conclusion Elderly patients aged over 80 in CHANCE-2 trial had higher risks of composite vascular events, disabling stroke, severe or moderate bleeding and mortality within 90 days. Genotype-guided DAPT might not be as effective in old-old patients as in younger ones.Trial registration number NCT04078737.Data are available on reasonable request.