Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial
Objectives Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited, especially those elder than 80 years. This study aimed to explore the efficacy and safety of dual antiplatelet therapy (DAPT) in old-old patients compared with younger patients in the ticagrelor...
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2024/01/29/svn-2023-002450.full |
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| author | Liping Liu Yongjun Wang Yilong Wang Zixiao Li Xingquan Zhao Jing Jing Philip M Bath Hao Li Xia Meng Anxin Wang Yong Jiang Xinmiao Zhang Jianhua Li Jinxi Lin S Claiborne Johnston Xinsheng Han Qin Xu Weifeng Chen Xuewei Xie Xuhai Gong |
| author_facet | Liping Liu Yongjun Wang Yilong Wang Zixiao Li Xingquan Zhao Jing Jing Philip M Bath Hao Li Xia Meng Anxin Wang Yong Jiang Xinmiao Zhang Jianhua Li Jinxi Lin S Claiborne Johnston Xinsheng Han Qin Xu Weifeng Chen Xuewei Xie Xuhai Gong |
| author_sort | Liping Liu |
| collection | DOAJ |
| description | Objectives Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited, especially those elder than 80 years. This study aimed to explore the efficacy and safety of dual antiplatelet therapy (DAPT) in old-old patients compared with younger patients in the ticagrelor or Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events-II (CHANCE-2) trial.Methods CHANCE-2 was a randomised, double-blind, placebo-controlled trial in China involving patients with high-risk transient ischaemic attack or minor stroke with CYP2C19 loss-of-function alleles. In our substudy, all enrolled patients were stratified by age: old-old (≥80 years), young-old (65–80 years) and younger (<65 years). The primary outcomes were stroke recurrence and moderate to severe bleeding within 90 days, respectively.Results Of all the 6412 patients, 406 (6.3%) were old-old, 2755 (43.0%) were young-old and 3251 (50.7%) were younger. Old-old patients were associated with higher composite vascular events (HR 1.41, 95% CI 1.00 to 1.98, p=0.048), disabling stroke (OR 2.43, 95% CI 1.52 to 3.88, p=0.0002), severe or moderate bleeding (HR 8.40, 95% CI 1.95 to 36.21, p=0.004) and mortality (HR 7.56, 95% CI 2.23 to 25.70, p=0.001) within 90 days. Ticagrelor-aspirin group was associated with lower risks of stroke recurrence within 90 days in younger patients (HR 0.68, 95% CI 0.51 to 0.91, p=0.008), which was no differences in old-old patients.Conclusion Elderly patients aged over 80 in CHANCE-2 trial had higher risks of composite vascular events, disabling stroke, severe or moderate bleeding and mortality within 90 days. Genotype-guided DAPT might not be as effective in old-old patients as in younger ones.Trial registration number NCT04078737. |
| format | Article |
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| series | Stroke and Vascular Neurology |
| spelling | doaj-art-0cb578aabf1948dfa5f5c2bf2bf026be2025-08-20T02:13:24ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2023-002450Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trialLiping Liu0Yongjun Wang1Yilong Wang2Zixiao Li3Xingquan Zhao4Jing Jing5Philip M Bath6Hao Li7Xia Meng8Anxin Wang9Yong Jiang10Xinmiao Zhang11Jianhua Li12Jinxi Lin13S Claiborne Johnston14Xinsheng Han15Qin Xu16Weifeng Chen17Xuewei Xie18Xuhai Gong19China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital,Capital Medical University, Fengtai, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Chinaprofessor4 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UKDepartment of Radiology, University of Cambridge, Cambridge, UKDepartment of Neurology, Beijing Tiantan Hospital,Capital Medical University, Fengtai, Beijing, China1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaThe First Hospital of Fangshan District, Beijing, Chinasenior lecturerprofessorKaifeng Central Hospital, Henan, China2 School of Nursing, Nanjing Medical University, 101Longmian Avenue,Jiangning District,Nanjing, 211166, ChinaDepartment of Neurology, Xingyang People`s Hospital, Henan, China1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDaqing Oilfield General Hospital, Daqing, Heilongjiang, ChinaObjectives Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited, especially those elder than 80 years. This study aimed to explore the efficacy and safety of dual antiplatelet therapy (DAPT) in old-old patients compared with younger patients in the ticagrelor or Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events-II (CHANCE-2) trial.Methods CHANCE-2 was a randomised, double-blind, placebo-controlled trial in China involving patients with high-risk transient ischaemic attack or minor stroke with CYP2C19 loss-of-function alleles. In our substudy, all enrolled patients were stratified by age: old-old (≥80 years), young-old (65–80 years) and younger (<65 years). The primary outcomes were stroke recurrence and moderate to severe bleeding within 90 days, respectively.Results Of all the 6412 patients, 406 (6.3%) were old-old, 2755 (43.0%) were young-old and 3251 (50.7%) were younger. Old-old patients were associated with higher composite vascular events (HR 1.41, 95% CI 1.00 to 1.98, p=0.048), disabling stroke (OR 2.43, 95% CI 1.52 to 3.88, p=0.0002), severe or moderate bleeding (HR 8.40, 95% CI 1.95 to 36.21, p=0.004) and mortality (HR 7.56, 95% CI 2.23 to 25.70, p=0.001) within 90 days. Ticagrelor-aspirin group was associated with lower risks of stroke recurrence within 90 days in younger patients (HR 0.68, 95% CI 0.51 to 0.91, p=0.008), which was no differences in old-old patients.Conclusion Elderly patients aged over 80 in CHANCE-2 trial had higher risks of composite vascular events, disabling stroke, severe or moderate bleeding and mortality within 90 days. Genotype-guided DAPT might not be as effective in old-old patients as in younger ones.Trial registration number NCT04078737.https://svn.bmj.com/content/early/2024/01/29/svn-2023-002450.full |
| spellingShingle | Liping Liu Yongjun Wang Yilong Wang Zixiao Li Xingquan Zhao Jing Jing Philip M Bath Hao Li Xia Meng Anxin Wang Yong Jiang Xinmiao Zhang Jianhua Li Jinxi Lin S Claiborne Johnston Xinsheng Han Qin Xu Weifeng Chen Xuewei Xie Xuhai Gong Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial Stroke and Vascular Neurology |
| title | Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial |
| title_full | Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial |
| title_fullStr | Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial |
| title_full_unstemmed | Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial |
| title_short | Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE-2 trial |
| title_sort | efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention a subgroup analysis of the chance 2 trial |
| url | https://svn.bmj.com/content/early/2024/01/29/svn-2023-002450.full |
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