Dual Antiplatelet Treatment up to 72 Hours After Ischemic Stroke Stratified by Risk Profile: A Post Hoc Analysis.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2025-01-01 Epub Date: 2024-12-20 DOI:10.1161/STROKEAHA.124.049246

Yanli Zhang, Xuan Wang, Ying Gao, Weiqi Chen, S Claiborne Johnston, Pierre Amarenco, Philip M Bath, Hongyi Yan, Tingting Wang, Yingying Yang, Qi Zhou, Mengxing Wang, Jing Jing, Chunjuan Wang, Yongjun Wang, Yilong Wang, Yuesong Pan

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Abstract

Background: Risk profile of recurrence may influence the effect of antiplatelet therapy. This study aimed to evaluate the efficacy and safety of clopidogrel-aspirin initiated within 72 hours after symptom onset for acute mild stroke or high-risk transient ischemic attack stratified by risk profile.

Methods: This is a secondary post hoc analysis of the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis) randomized clinical trial that enrolled patients 35 to 80 years old with acute mild ischemic stroke or high-risk transient ischemic attack between 2018 and 2022. Patients were stratified into different groups based on the Essen Stroke Risk Score (ESRS) and modified ESRS. The primary efficacy outcome was any new stroke within 90 days. The primary safety outcome was moderate-to-severe bleeding within 90 days.

Results: Among 6100 patients (3050 each in the clopidogrel-aspirin group and aspirin group), the median age was 65 years (interquartile range, 57-71 years), and 3915 (64.2%) were male. Clopidogrel-aspirin was associated with a reduced risk of new stroke in patients with an ESRS of <3 (hazard ratio [HR], 0.67 [95% CI, 0.52-0.86]), but not in those with an ESRS of ≥3 (HR, 0.92 [95% CI, 0.72-1.18]), compared with aspirin (P_interaction=0.07). Similar results were found in patients stratified by modified ESRS (modified ESRS <6 in male and <5 in female: HR, 0.68 [95% CI, 0.55-0.83]; modified ESRS ≥6 in male and ≥5 in female: HR, 1.14 [95% CI, 0.82-1.59]; P_interaction=0.01). The association between antiplatelet therapy and the moderate-to-severe bleeding did not differ across risk profile subgroups (ESRS of <3: HR, 1.35 [95% CI, 0.54-3.35]; ESRS of ≥3: HR, 3.21 [95% CI, 1.18-8.78]; P_interaction=0.21; modified ESRS of <6 in male and <5 in female: HR, 1.96 [95% CI, 0.88-4.36]; modified ESRS of ≥6 in male and ≥5 in female: HR, 2.27 [95% CI, 0.70-7.39]; P_interaction=0.85).

Conclusions: This post hoc analysis of the INSPIRES trial showed that patients with a low level of risk profile assessed by ESRS received greater benefit from clopidogrel-aspirin initiated within 72 hours after symptom onset than aspirin alone.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03635749.

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缺血性脑卒中后 72 小时内的双联抗血小板治疗按风险特征进行分层：事后分析

背景：复发的风险特征可能影响抗血小板治疗的效果。本研究旨在评估急性轻度卒中或高风险短暂性脑缺血发作症状出现后72小时内服用氯吡格雷-阿司匹林的疗效和安全性。方法：这是一项对inspire（强化他汀类药物和抗血小板治疗急性高危颅内或颅外动脉粥样硬化）随机临床试验的二次分析，该试验纳入了2018年至2022年间35至80岁的急性轻度缺血性卒中或高风险短暂性缺血性发作患者。根据Essen卒中风险评分（ESRS）和修正ESRS将患者分为不同的组。主要疗效指标为90天内任何新的卒中。主要安全性指标为90天内中度至重度出血。结果：6100例患者中（氯吡格雷-阿司匹林组和阿司匹林组各3050例），年龄中位数为65岁（四分位数间距为57 ~ 71岁），男性3915例（64.2%）。氯吡格雷-阿司匹林与ESRS（相互作用=0.07）患者新发卒中风险降低相关。改良ESRS分层的患者结果相似（改良ESRS p - interaction=0.01）。抗血小板治疗与中重度出血之间的相关性在不同风险状况亚组间没有差异(p相互作用的ESRS =0.21；p - interaction的修正ESRS =0.85)。结论：这项对inspire试验的事后分析显示，ESRS评估的低风险水平患者在症状出现后72小时内服用氯吡格雷-阿司匹林比单独服用阿司匹林获益更大。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03635749。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.