Article Text
Abstract
Objective Many patients receiving dual antiplatelet therapy still had recurrent strokes. We aimed to identify factors associated with recurrent stroke at 90 days in patients receiving dual antiplatelet therapy in Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial.
Methods Patients with transient ischaemic attack or minor stroke receiving clopidogrel and aspirin in the trial were analysed in the study. The primary outcome was recurrent stroke within 90 days after the index event. Cox proportional hazard model with backward selection was used to identify factors associated with stroke.
Results Among 2584 patients, 212 (8.2%) had a recurrent stroke, 216 (8.4%) had a composite of stroke, myocardial infarction, or vascular death and 204 (7.9%) had ischaemic stroke within 90 days. Multivariate analysis identified the following factors associated with stroke: history of hypertension with poor blood pressure control (HR, 1.92; 95% CI 1.22 to 3.03), the high baseline National Institute of Health Stroke Scale (NIHSS) score of 2 and 3 (2.12 (1.07 to 4.21) and 4.11 (2.05 to 8.22), respectively), time from onset to randomisation of <12 hours (1.47 (1.12 to 1.94)), the lipid-lowering therapy (0.61 (0.47 to 0.83)), the open-label aspirin dose at day 1 of ≥300 mg (1.98 (1.45 to 2.69)). Intracranial arterial stenosis (ICAS) was significantly associated with stroke in the sensitivity analysis (2.17 (1.16 to 4.04)).
Conclusions The high baseline NIHSS score, hypertension with poor blood pressure control, ICAS, time from onset to randomisation of less than 12 hours and no lipid-lowering therapy were associated with stroke, suggesting that patients with identified predictors still remain to be at high risk of recurrent stroke although being under the dual antiplatelet therapy.
Trial registration number http://clinicaltrials.gov/show/NCT00979589. ClinicalTrials.gov number: NCT00979589
- Transient ischemic attack
- Acute ischemic minor stroke
- Dual antiplatelet therapy
- Recurrent stroke
- Risk factor.
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Footnotes
RW and XW contributed equally.
Contributors YJW, YLW, XQZ contributed to conception and design of the study. RQW and XWW drafted the manuscript or tables or figures. YJW, YLW and YX contributed to comments on the draft manuscript and revised the report. Site investigators contributed to data acquisition not analysis. YLW and LPL coordinated the study. XM and XWW oversaw the subject recruitment and monitored gathering clinical data. HL conducted the statistical analysis.
Funding The study was supported by grants from the Ministry of Science and Technology of the People’s Republic of China and Program for New Century Excellent Talents in University. The grant numbers are 2008ZX09312-008, 2011BAI08B02, 2012ZX09303, 200902004 and NCET-13–0917.
Competing interests None declared.