Clopidogrel Plus Aspirin Prevents Early Neurologic Deterioration and Improves 6-Month Outcome in Patients With Acute Large Artery Atherosclerosis Stroke

Chün, Wang; Yi, Xingyang; Zhang, Biao; Liao, Duanxiu; Lin, Jing; Chi, Lifen

doi:10.1177/1076029614551823

Cited by 36 publications

(41 citation statements)

References 45 publications

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“…We fully agree with the authors who customized antiplatelet therapy based on platelet function assays and their results that showed lower rates of recurrent events after platelet reactivity-guided modification of therapy [22,23]. In addition, there have been reports about dual antiplatelet therapy (ASA plus clopidogrel) that could be effective and beneficial for the large artery atherosclerosis etiologic subtype of stroke [24,25] and that dual antiplatelet therapy is associated with a lower risk of HTPR [7]. Considering the results obtained in our study, this provides further support for updating the stroke guidelines and recommendations.…”

Section: Discussionsupporting

confidence: 76%

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

et al. 2020

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Background: The aim of this prospective, a three-year follow-up study, was to establish the role of high on-treatment platelet reactivity (HTPR) in predicting the recurrence of vascular events in patients after cerebrovascular incidents, particularly in the aspect of stroke etiology. Methods:The study included 101 subjects with non-embolic cerebral ischemia (69 patients with ischemic stroke and 32 patients with transient ischemic attack) treated with 150 mg of acetylsalicylic acid (aspirin) a day. The platelet reactivity was tested in the first 24 h after the onset of cerebral ischemia by impedance aggregometry. Recurrent vascular events, including recurrent ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, or sudden death of vascular reason, were assessed 36 months after the onset of cerebral ischemia. Results: Recurrent vascular events occurred between 3 and 9 months after onset in 8.5% of all subjects; in the HTPR subgroup, recurrent vascular events occurred in 17.9%; in the normal on-treatment platelet reactivity (NTPR) subgroup, they occurred in 4.6%. We did not notice early or long-term recurrent events. Aspirin resistant subjects had a significantly higher risk of recurrent vascular events than did aspirin sensitive subjects (Odds ratio (OR) = 4.57, 95% Confidence interval (CI) 1.00-20.64; p = 0.0486). Cox proportional hazard models showed that large-vessel disease (Hazard ratio (HR) 12.04, 95% CI 2.43-59.72; p = 0.0023) and high on-treatment platelet reactivity (HR 4.28, 95% CI 1.02-17.93; p = 0.0465) were independent predictors of recurrent vascular events. Conclusion: Aspirin resistance in the acute phase of cerebral ischemia was associated with a higher risk of recurrent medium-term vascular events, coexisting with large-vessel etiology of stroke. Platelet function-guided personalized antiplatelet treatment should be considered for patients with recurrent strokes, especially when due to large-vessel disease.

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Section: Discussionsupporting

confidence: 76%

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

et al. 2020

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“…In particular, dual antiplatelet therapy (aspirin and clopidogrel) with high-intensity statin was prescribed in those patients for several months according to a guideline from the American Heart Association and American Stroke Association [ 23 ]. This practice is further supported by the results of a recent study showing that a short course (a month) of dual antiplatelet therapy reduced END and stroke recurrence in patients with acute LAA stroke [ 24 ]. Noticeably, the effect of dual antiplatelet therapy was higher in patients with posterior circulation stroke and basilar stenosis in that study.…”

Section: Discussionmentioning

confidence: 72%

Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke

Lee

2017

PLoS ONE

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Background and purposeEarly neurologic deterioration (END) during the acute stage of stroke is clinically important because of its association with poor outcomes. The purpose of this study was (1) to investigate variables associated with END, (2) to determine the distribution of atherosclerotic stenosis associated with END, and (3) to clarify the relationship between END and clinical outcomes.Methods516 patients with acute ischemic stroke were included. The median follow-up period was 31.7 months. END was defined as a ≥2 point increase in the National Institutes of Health Stroke Scale (NIHSS), ≥1 point increase in level of consciousness or motor item of the NIHSS, or the development of any new neurological deficits during the first 72 hours of hospitalization. A signal loss on 1.5-T magnetic resonance angiography exceeding 50% was considered to be significant for the categorization of stenosis pattern.ResultsThe prevalence of END was 19.0%. END was associated with intracranial atherosclerotic stenosis (IAS) together with large artery atherosclerosis (LAA) subtype. In particular, stenosis of basilar artery or posterior cerebral artery was independently associated with END. Lesion growth or hypoperfusion was more accountable for END in patients with IAS, whereas intracerebral hemorrhage or edema/herniation was more frequently observed in END patients without IAS. Patients with END had a higher rate of mortality, but a similar rate of further vascular events compared to patients without END.ConclusionPre-stroke IAS and LAA subtype could determine the development of END during the acute stage of ischemic stroke.

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“…Our previous studies and some other studies have shown that platelet activation plays a key role in the pathogenesis of IS and RIS [Marquardt et al . 2002; Wang et al . 2015; Yi et al .…”

Section: Discussionmentioning

confidence: 99%

Interactions among COX-2, GPIIIa and P2Y1 variants are associated with aspirin responsiveness and adverse events in patients with ischemic stroke

Han

Zhou

et al. 2016

Ther Adv Neurol Disord

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Background:The effect of gene variants and their interactions on response to aspirin and clinical adverse outcomes after an acute ischemic stroke (IS) is not fully understood. The aim of this study was to investigate the association of aspirin-relevant gene variants and their interactions with clinical adverse outcomes in IS patients taking aspirin.Methods:A total of 14 variants from six genes encoding COX enzymes (COX-1, COX-2), platelet membrane receptors (TXAS1, P2Y1, P2Y12) and glycoprotein receptor (GPIIIa) were examined in 850 acute IS patients. Gene–gene interactions were analyzed using generalized multifactor dimensionality reduction (GMDR) analysis. All patients were followed up for 1 year after admission. Primary outcome was a composite of recurrent ischemic stroke (RIS), myocardial infarction (MI) and death.Results:The primary outcome occurred in 112 (13.5%) patients (81 RIS, 16 MI and 15 deaths). There were no significant differences in the frequencies of the genotypes of the 14 variants between the patients with and without primary outcome using single-locus analytical approach. However, there was significant gene–gene interaction among rs20417, rs1371097 and rs2317676. The high-risk interactive genotypes of rs20417, rs1371097 and rs2317676 were independently associated with primary adverse outcome of RIS, MI, and death after acute IS.Conclusion:The three-loci interactions are associated with sensitivity of IS patients to aspirin and aspirin-induced adverse clinical events. The combinatorial analysis used in this study may be helpful to elucidate complex genetic risk of aspirin resistance (AR).Clinical trial registration:The study described here is registered at http://www.chictr.org/ (unique identifier: ChiCTR-OCH-14004724).

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Clopidogrel Plus Aspirin Prevents Early Neurologic Deterioration and Improves 6-Month Outcome in Patients With Acute Large Artery Atherosclerosis Stroke

Abstract: Clopidogrel plus aspirin is superior to aspirin alone for reducing END and RIS within 30 days and improves outcomes in certain subgroups at 6 months.

Cited by 36 publications

References 45 publications

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke

Interactions among COX-2, GPIIIa and P2Y1 variants are associated with aspirin responsiveness and adverse events in patients with ischemic stroke

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