Clopidogrel with aspirin in acute minor stroke or transient ischemic attack
Yongjun Wang, Yilong Wang, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Chen Wang, Hao Li, Xia Meng, Liying Cui, Jianping Jia, Qiang Dong, Anding Xu, Jinsheng Zeng, Yansheng Li, Zhimin Wang, Haiqin Xia, S Claiborne Johnston, CHANCE Investigators, Yongjun Wang, Claiborne Johnston, Lawrence Wong, David Wang, James Wang, Mai N Nguyen-Huynh, Chen Wang, Liying Cui, Yansheng Li, Qiang Dong, Jianfeng Xu, Jianping Jia, Jiang Wu, Jinsheng Zeng, Xingquan Zhao, Liping Liu, Chunxue Wang, Yilong Wang, Yongjun Wang, Claiborne Johnston, Yilong Wang, Xingquan Zhao, Liping Liu, Xia Meng, Anxin Wang, Jinxi Lin, Zhimin Wang, Yongjun Wang, Haiqin Xia, Bin Li, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, WeiguoTang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling-Lv Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Li He, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, HaoHu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, ShiminWang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian, Chen Wang, Yilong Wang, Xia Meng, Jinxi Lin, Anxin Wang, Yong Zhou, Xianwei Wang, Chao Li, Yuan Shen, Xianhong Liang, Jing Jing, Yilong Wang, Anxin Wang, Gaifen Liu, Xianwei Wang, Yuesong Pan, Zhigang Zhao, Xia Meng, Haibo Wu, Yongjun Wang, Claiborne Johnston, Yilong Wang, David Wang, Lawrence Wong, David Wang, James Wang, Yansheng Li, Anding Xu, Peiyi Gao, Haibo Wu, Hao Li, Haipeng Shen, Jianfeng Xu, Yu Yan, Yong Jiang, Yongjun Wang, Yilong Wang, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Chen Wang, Hao Li, Xia Meng, Liying Cui, Jianping Jia, Qiang Dong, Anding Xu, Jinsheng Zeng, Yansheng Li, Zhimin Wang, Haiqin Xia, S Claiborne Johnston, CHANCE Investigators, Yongjun Wang, Claiborne Johnston, Lawrence Wong, David Wang, James Wang, Mai N Nguyen-Huynh, Chen Wang, Liying Cui, Yansheng Li, Qiang Dong, Jianfeng Xu, Jianping Jia, Jiang Wu, Jinsheng Zeng, Xingquan Zhao, Liping Liu, Chunxue Wang, Yilong Wang, Yongjun Wang, Claiborne Johnston, Yilong Wang, Xingquan Zhao, Liping Liu, Xia Meng, Anxin Wang, Jinxi Lin, Zhimin Wang, Yongjun Wang, Haiqin Xia, Bin Li, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, WeiguoTang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling-Lv Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Li He, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, HaoHu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, ShiminWang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian, Chen Wang, Yilong Wang, Xia Meng, Jinxi Lin, Anxin Wang, Yong Zhou, Xianwei Wang, Chao Li, Yuan Shen, Xianhong Liang, Jing Jing, Yilong Wang, Anxin Wang, Gaifen Liu, Xianwei Wang, Yuesong Pan, Zhigang Zhao, Xia Meng, Haibo Wu, Yongjun Wang, Claiborne Johnston, Yilong Wang, David Wang, Lawrence Wong, David Wang, James Wang, Yansheng Li, Anding Xu, Peiyi Gao, Haibo Wu, Hao Li, Haipeng Shen, Jianfeng Xu, Yu Yan, Yong Jiang
Abstract
Background: Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone.
Methods: In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-to-treat analysis. Treatment differences were assessed with the use of a Cox proportional-hazards model, with study center as a random effect.
Results: Stroke occurred in 8.2% of patients in the clopidogrel-aspirin group, as compared with 11.7% of those in the aspirin group (hazard ratio, 0.68; 95% confidence interval, 0.57 to 0.81; P<0.001). Moderate or severe hemorrhage occurred in seven patients (0.3%) in the clopidogrel-aspirin group and in eight (0.3%) in the aspirin group (P=0.73); the rate of hemorrhagic stroke was 0.3% in each group.
Conclusions: Among patients with TIA or minor stroke who can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first 90 days and does not increase the risk of hemorrhage. (Funded by the Ministry of Science and Technology of the People's Republic of China; CHANCE ClinicalTrials.gov number, NCT00979589.).
Source: PubMed