Abstract:

Objective To evaluate the effect of clopidogrel plus aspirin dual antiplatelet therapy on functional outcome in patients with minor stroke or TIA. Methods Individual patient-level data from the CHANCE and POINT trial were extracted and pooled. In the 2 trials, the patients were randomly given clopidogrel plus aspirin or aspirin alone within 12 hours (POINT) or 24 hours (CHANCE) from symptom onset. The main outcome were poor functional outcome (mRS≥2), and 3-level ordinal stroke scale [classified as disabling or fatal recurrent stroke (mRS≥2), nondisabling recurrent stroke (mRS 0 or 1) and no recurrent stroke]. Results This analysis included individual data from 10 013 patients, of which 5132 patients (51.3%) were derived from the CHANCE trial and 4881 (48.7%) were derived from the POINT trial, with 4995 (49.9%) cases were in clopidogrel plus aspirin group and 5018 (50.1%) were in aspirin alone group. The proportion of patients with poor functional outcome at 3 months in clopidogrel plus aspirin group was lower than that in aspirin alone group (11.6% vs 12.6%, adjusted OR 0.82, 95%CI 0.72- 0.94, P =0.005). Compared with the aspirin alone group, the dual antiplatelet therapy group also had lower risk of disabling or fatal recurrent stroke (4.6% vs 6.1%, adjusted OR 0.73, 95%CI 0.61- 0.87, P <0.001), nondisabling recurrent stroke (1.9% vs 3.0%, adjusted OR 0.62, 95%CI 0.47-0.80, P <0.001) and the overall disability for recurrent stroke (adjusted common OR 0.70, 95%CI 0.60-0.81, P <0.001). Conclusions Compared to aspirin alone, clopidogrel plus aspirin dual antiplatelet therapy can further improved functional outcome and reduced disabling recurrent stroke at 3 months in patients with minor ischemic stroke or TIA. 

Key words: Clopidogrel; Minor stroke; Transient ischemic attack; Functional outcome;Disability

摘要：

目的 评价氯吡格雷联合阿司匹林双抗治疗对轻型缺血性卒中与TIA患者功能预后的影响。 方法 提取CHANCE和POINT试验所有的个体数据。这两项试验中，所有纳入患者在症状发作12 h （POINT）或24 h（CHANCE）以内随机接受氯吡格雷联用阿司匹林或单用阿司匹林治疗。结局指标为3个 月时功能预后不良（mRS≥2），三等级定义卒中复发[致残性或致死性卒中复发（mRS≥2）、非致残性 卒中复发（mRS 0或1）、无卒中复发]。 结果 共10 013例患者纳入分析，其中来自CHANCE试验5132例（51.3%），来自POINT试验4881例 （48.7%）；氯吡格雷联用阿司匹林组4995例（49.9%），单用阿司匹林组5018例（50.1%）。氯吡格雷联 用阿司匹林组3个月时功能预后不良的患者比例低于单用阿司匹林组（11.6% vs 12.6%，校正OR 0.82， 95%CI 0.72～0.94，P =0.005）。氯吡格雷联用阿司匹林组致残性或致死性卒中复发（4.6% vs 6.1%， 校正OR 0.73，95%CI 0.61～0.87，P <0.001）、非致残性卒中复发（1.9% vs 3.0%，校正OR 0.62，95%CI 0.47～0.80，P <0.001）和卒中复发的整体致残性（校正cOR 0.70，95%CI 0.60～0.81，P <0.001）低于单 用阿司匹林组。 结论 与单用阿司匹林治疗相比，氯吡格雷联用阿司匹林治疗可进一步改善轻型缺血性卒中和TIA 患者3个月时功能预后，减少致残性卒中复发。

关键词: 氯吡格雷; 轻型卒中; 短暂性脑缺血发作; 功能预后; 残疾