Platelet Aggregation Function-Guided De-Escalation Antiplatelet Therapy in Patients With Acute Ischemic Stroke (PATH STROKE D)

June 8, 2026 updated by: Jie Yang, Sichuan Provincial People's Hospital

This multicenter, prospective, open-label, randomized controlled trial will evaluate whether platelet aggregation function-guided de-escalation of antiplatelet therapy is non-inferior in efficacy and superior in safety compared with standard dual antiplatelet therapy in patients with acute minor ischemic stroke or high-risk transient ischemic attack who are sensitive to clopidogrel.

Participants who present within 48 hours of symptom onset and meet the eligibility criteria will receive loading doses of clopidogrel and aspirin, followed by platelet aggregation function testing. Eligible clopidogrel-sensitive participants will be randomized to receive either 7 days of dual antiplatelet therapy followed by clopidogrel monotherapy or standard 21-day dual antiplatelet therapy followed by single antiplatelet therapy. The primary efficacy outcome is new stroke within 90 days after randomization.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

3836

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Jie Yang Deputy Director of the Department of Neurology
  • Phone Number: +8613678130516
  • Email: yangjie1126@163.com

Study Locations

  • China
    • Sichuan
      • Chengdu, Sichuan, China, 610072
        • Sichuan Provincial People's Hospital
        • Contact:
          • Jie Yang Deputy Director of the Department of Neurology
          • Phone Number: +86 13678130516
          • Email: yangjie1126@163.com

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 1.Age 18 years or older. 2.Diagnosis of acute non-disabling ischemic stroke or transient ischemic attack according to World Health Organization criteria, meeting one of the following definitions: acute non-disabling ischemic stroke, defined as a National Institutes of Health Stroke Scale score of 5 or lower at enrollment; or high-risk transient ischemic attack, defined as an ABCD2 score of 4 or higher.

    3.Symptom onset within 48 hours. Onset time is defined as the interval from the last time the participant was known to be well to the time of combined administration of clopidogrel 300 mg and aspirin 100 mg.

    4.MARADP <35% measured 5 to 20 hours after combined antiplatelet treatment with clopidogrel 300 mg and aspirin 100 mg within 48 hours of symptom onset.

    5.Planned treatment with aspirin plus clopidogrel or clopidogrel monotherapy for antiplatelet therapy.

    6.Written informed consent provided by the participant or a legally authorized representative.

Exclusion Criteria:1.Imaging evidence of hemorrhagic stroke, hemorrhagic transformation, or another pathological brain disorder, such as vascular malformation, tumor, abscess, or another common non-ischemic brain disease such as multiple sclerosis.

2.Minor stroke or transient ischemic attack caused by angioplasty or vascular surgery.

3.Atrial fibrillation indicated by standard electrocardiography or typical physical signs of atrial fibrillation, including absolutely irregular rhythm, variable intensity of the first heart sound, or pulse deficit.

4.A clear indication for anticoagulation, including suspected cardioembolism such as atrial fibrillation, known artificial heart valve, or suspected endocarditis.

5.Intravenous thrombolysis, intra-arterial thrombolysis, mechanical thrombectomy, or any revascularization procedure performed after the index event or planned within 90 days.

6.Use of antiplatelet agents other than aspirin or clopidogrel within 7 days before enrollment, such as ticagrelor or prasugrel.

7.History of gastrointestinal bleeding, intracranial hemorrhage, recent major bleeding or blood transfusion, excluding minor hemoptysis or minor abnormal vaginal bleeding, or other bleeding disorder caused by coagulation dysfunction, such as purpura.

8.Contraindication or intolerance to clopidogrel or aspirin, including known allergy; severe hepatic insufficiency or renal insufficiency; severe heart failure; coagulation disorder or history of systemic bleeding; history of thrombocytopenia or neutropenia; or history of drug-induced hematologic disease or hepatic dysfunction.

9.Leukopenia, defined as white blood cell count <2 x 10^9/L, or thrombocytopenia, defined as platelet count <100 x 10^9/L.

10.Use of heparin or oral anticoagulants within 10 days before enrollment. 11.Severe cardiac, pulmonary, hepatic, or renal dysfunction, or severe comorbid disease such as tumor, chronic airflow disease, severe dementia, or severe heart failure.

12.Female participants of childbearing potential with a negative pregnancy test who refuse to use effective contraception, or women who are pregnant or breastfeeding.

13.Poor compliance or inability to complete study requirements.

-

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Shortened Dual Antiplatelet Therapy (7-Day DAPT → Clopidogrel Monotherapy)
Participants will receive clopidogrel 75 mg orally once daily plus aspirin 100 mg orally once daily on Days 1-7, followed by clopidogrel 75 mg orally once daily on Days 8-90. Antiplatelet therapy after Day 90 will be determined by the treating physician.
Drug: Clopidogrel
Clopidogrel will be administered according to the assigned antiplatelet strategy. Participants receive a loading dose during screening and then clopidogrel 75 mg orally once daily during the assigned treatment period.
Drug: Aspirin
Aspirin will be administered according to the assigned antiplatelet strategy. Participants receive aspirin during screening and then aspirin 100 mg orally once daily during the assigned treatment period.
Active Comparator: Standard Dual Antiplatelet Therapy (21-Day DAPT → Single Antiplatelet)
Participants receive clopidogrel 75 mg once daily plus aspirin 100 mg once daily on Days 1-21, followed by clopidogrel 75 mg once daily or aspirin 100 mg once daily on Days 22-90. Therapy after Day 90 is determined by the treating physician.
Drug: Clopidogrel
Clopidogrel will be administered according to the assigned antiplatelet strategy. Participants receive a loading dose during screening and then clopidogrel 75 mg orally once daily during the assigned treatment period.
Drug: Aspirin
Aspirin will be administered according to the assigned antiplatelet strategy. Participants receive aspirin during screening and then aspirin 100 mg orally once daily during the assigned treatment period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Recurrent stroke (including ischemic and hemorrhagic stroke) within 90 days
Time Frame: within 90 days
within 90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
New stroke at prespecified follow-up visits
Time Frame: At Day 7 or hospital discharge, Day 30 and 1 year after randomization
At Day 7 or hospital discharge, Day 30 and 1 year after randomization
New vascular events
Time Frame: At Day 7 or hospital discharge, Day 30, Day 90, and 1 year after randomization
Including cardiovascular and cerebrovascular strokes, myocardial infarctions, and vascular deaths.
At Day 7 or hospital discharge, Day 30, Day 90, and 1 year after randomization
Modified Rankin Scale score
Time Frame: At Day 30, Day 90, 1 year, and 2 years after randomization
The score range of the scale is from 0 to 6. The higher the score, the worse the outcome.
At Day 30, Day 90, 1 year, and 2 years after randomization
New ischemic stroke
Time Frame: At Day 7 or hospital discharge, Day 30, Day 90, and 1 year after randomization
At Day 7 or hospital discharge, Day 30, Day 90, and 1 year after randomization
Worsening of nerve damage (an increase in the NIHSS score by ≥ 4 points compared to the baseline)
Time Frame: At 24 hours and at Day 7 or hospital discharge after randomization
At 24 hours and at Day 7 or hospital discharge after randomization
Quality of life at day 90 [assessed by the EuroQol - 5 dimension (EQ - 5D) questionnaire]
Time Frame: At Day 90 after randomization
It is usually represented by a value between 0 and 1, where 1 represents perfect health, 0 represents death, and the intermediate values reflect different degrees of health status.
At Day 90 after randomization

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sichuan Provincial People's Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 1, 2026

Primary Completion (Estimated)

December 1, 2028

Study Completion (Estimated)

October 1, 2029

Study Registration Dates

First Submitted

June 8, 2026

First Submitted That Met QC Criteria

June 8, 2026

First Posted (Actual)

June 12, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 8, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IITLX2026028

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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