Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke
Background This study aimed to assess the clinical outcome among patients with minor stroke, both with and without disabling neurologic deficits (DNDs). It sought to investigate the efficacy of antiplatelet therapy using clopidogrel–aspirin versus aspirin alone within the framework of the CHANCE (Cl...
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| Format: | Article |
| Language: | English |
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.029734 |
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| author | Chong Han Ming Yang Yuesong Pan Hao Li Liping Liu Xia Meng Yilong Wang Yongjun Wang |
| author_facet | Chong Han Ming Yang Yuesong Pan Hao Li Liping Liu Xia Meng Yilong Wang Yongjun Wang |
| author_sort | Chong Han |
| collection | DOAJ |
| description | Background This study aimed to assess the clinical outcome among patients with minor stroke, both with and without disabling neurologic deficits (DNDs). It sought to investigate the efficacy of antiplatelet therapy using clopidogrel–aspirin versus aspirin alone within the framework of the CHANCE (Clopidogrel in High‐Risk Patients With Acute Nondisabling Cerebrovascular Events) trial. Methods and Results We enrolled 3725 patients with minor stroke from the CHANCE trial. Patients were divided into 2 groups: those with DNDs and those without, based on the presence or absence of DND, as determined by the baseline National Institutes of Health Stroke Scale score. The interaction between the treatment effects of antiplatelet therapy in patients with or without DNDs was analyzed using the Cox proportional hazards regression model. Of all enrolled patients, 1918 (51.5%) had DNDs, and 1807 (48.5%) did not. Patients with DNDs exhibited a higher risk of stroke recurrence at 90 days compared with those without (11.9% versus 8.5%; P=0.008). Dual antiplatelet therapy with clopidogrel and aspirin was associated with a reduced risk of recurrent stroke compared with the mono antiplatelet therapy in both patients with DND and patients without DNDs (adjusted hazard ratios, 0.74 [95% CI, 0.57–0.96] and 0.64 [95% CI, 0.46–0.88], respectively). There was no significant interaction between DNDs and antiplatelet therapy in reducing stroke recurrence (interaction P=0.634). Conclusions DNDs appear to correlate with an elevated risk of recurrent stroke in patients with minor stroke. Dual antiplatelet therapy demonstrates superiority over aspirin alone in reducing the risk of subsequent stroke events within 90 days in patients, regardless of the presence of DNDs. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00979589. |
| format | Article |
| id | doaj-art-98aa7a8dcb154c3c988a5f6d5f0a88cc |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-98aa7a8dcb154c3c988a5f6d5f0a88cc2025-08-20T03:08:13ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.122.029734Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor StrokeChong Han0Ming Yang1Yuesong Pan2Hao Li3Liping Liu4Xia Meng5Yilong Wang6Yongjun Wang7Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaBackground This study aimed to assess the clinical outcome among patients with minor stroke, both with and without disabling neurologic deficits (DNDs). It sought to investigate the efficacy of antiplatelet therapy using clopidogrel–aspirin versus aspirin alone within the framework of the CHANCE (Clopidogrel in High‐Risk Patients With Acute Nondisabling Cerebrovascular Events) trial. Methods and Results We enrolled 3725 patients with minor stroke from the CHANCE trial. Patients were divided into 2 groups: those with DNDs and those without, based on the presence or absence of DND, as determined by the baseline National Institutes of Health Stroke Scale score. The interaction between the treatment effects of antiplatelet therapy in patients with or without DNDs was analyzed using the Cox proportional hazards regression model. Of all enrolled patients, 1918 (51.5%) had DNDs, and 1807 (48.5%) did not. Patients with DNDs exhibited a higher risk of stroke recurrence at 90 days compared with those without (11.9% versus 8.5%; P=0.008). Dual antiplatelet therapy with clopidogrel and aspirin was associated with a reduced risk of recurrent stroke compared with the mono antiplatelet therapy in both patients with DND and patients without DNDs (adjusted hazard ratios, 0.74 [95% CI, 0.57–0.96] and 0.64 [95% CI, 0.46–0.88], respectively). There was no significant interaction between DNDs and antiplatelet therapy in reducing stroke recurrence (interaction P=0.634). Conclusions DNDs appear to correlate with an elevated risk of recurrent stroke in patients with minor stroke. Dual antiplatelet therapy demonstrates superiority over aspirin alone in reducing the risk of subsequent stroke events within 90 days in patients, regardless of the presence of DNDs. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00979589.https://www.ahajournals.org/doi/10.1161/JAHA.122.029734antiplatelet therapydisabling neurologic deficitsischemic strokeNIH Stroke Scalestroke recurrence |
| spellingShingle | Chong Han Ming Yang Yuesong Pan Hao Li Liping Liu Xia Meng Yilong Wang Yongjun Wang Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease antiplatelet therapy disabling neurologic deficits ischemic stroke NIH Stroke Scale stroke recurrence |
| title | Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke |
| title_full | Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke |
| title_fullStr | Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke |
| title_full_unstemmed | Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke |
| title_short | Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke |
| title_sort | disabling neurologic deficits and antiplatelet therapy in acute minor stroke |
| topic | antiplatelet therapy disabling neurologic deficits ischemic stroke NIH Stroke Scale stroke recurrence |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.029734 |
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