Trends in Dual Antiplatelet Therapy of Aspirin and Clopidogrel and Outcomes in Ischemic Stroke Patients Noneligible for POINT/CHANCE Trial Treatment

• Published in: Journal of the American Heart Association Vol. 13; no. 10; p. e033611
• Main Authors: Kim, Joon‐Tae, Lee, Ji Sung, Kim, Hyunsoo, Kim, Beom Joon, Lee, Keon‐Joo, Park, Jong‐Moo, Kang, Kyusik, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae‐Kwan, Kim, Dae‐Hyun, Park, Tai Hwan, Lee, Kyungbok, Lee, Jun, Hong, Keun‐Sik, Cho, Yong‐Jin, Park, Hong‐Kyun, Lee, Byung‐Chul, Yu, Kyung‐Ho, Oh, Mi Sun, Kim, Dong‐Eog, Choi, Jay Chol, Kwon, Jee‐Hyun, Kim, Wook‐Joo, Shin, Dong‐Ick, Yum, Kyu Sun, Sohn, Sung Il, Hong, Jeong‐Ho, Lee, Sang‐Hwa, Park, Man‐Seok, Ryu, Wi‐Sun, Park, Kwang‐Yeol, Lee, Juneyoung, Saver, Jeffrey L., Bae, Hee‐Joon
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 21.05.2024; Wiley
• Subjects: acute ischemic stroke; Aged; Aged, 80 and over; aspirin; Aspirin - therapeutic use; clopidogrel; Clopidogrel - therapeutic use; Drug Therapy, Combination; Dual Anti-Platelet Therapy - adverse effects; dual antiplatelet treatment; Female; Humans; Ischemic Stroke - diagnosis; Ischemic Stroke - drug therapy; Ischemic Stroke - mortality; Ischemic Stroke - prevention & control; Japan - epidemiology; late‐presenting stroke; Male; Middle Aged; nonminor stroke; Original Research; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Registries; Risk Factors; Secondary Prevention - methods; Secondary Prevention - trends; Time Factors; Treatment Outcome; Japan; clopidogrel; aspirin; late‐presenting stroke; dual antiplatelet treatment; nonminor stroke; acute ischemic stroke
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.033611

Recent clinical trials established the benefit of dual antiplatelet therapy with aspirin and clopidogrel (DAPT-AC) in early-presenting patients with minor ischemic stroke. However, the impact of these trials over time on the use and outcomes of DAPT-AC among the patients with nonminor or late-presenting stroke who do not meet the eligibility criteria of these trials has not been delineated. In a multicenter stroke registry, this study examined yearly changes from April 2008 to August 2022 in DAPT-AC use for stroke patients ineligible for CHANCE/POINT (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events/Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) clinical trials due to National Institutes of Health Stroke Scale >4 or late arrival beyond 24 hours of onset. A total of 32 118 patients (age, 68.1±13.1 years; male, 58.5%) with National Institutes of Health Stroke Scale of 4 (interquartile range, 1-7) were analyzed. In 2008, DAPT-AC was used in 33.0%, other antiplatelets in 62.7%, and no antiplatelet in 4.3%. The frequency of DAPT-AC was relatively unchanged through 2013, when the CHANCE trial was published, and then increased steadily, reaching 78% in 2022, while other antiplatelets decreased to 17.8% in 2022 ( <0.001). From 2011 to 2022, clinical outcomes nonsignificantly improved, with an average relative risk reduction of 2%/y for the composite of stroke, myocardial infarction, and all-cause mortality, both among patients treated with DAPT-AC and patients treated with other antiplatelets. Use of DAPT-AC in stroke patients with stroke ineligible for recent DAPT clinical trials increased markedly and steadily after CHANCE publication in 2013, reaching deployment in nearly 4 of every 5 patients by 2022. The secondary prevention in patients with ischemic stroke seems to be gradually improving, possibly due to the enhancement of risk factor control.