Dual versus mono antiplatelet therapy in mild‐to‐moderate stroke during hospitalization

Abstract

Objective Subsequent vascular events are common after acute ischemic stroke during hospitalization. This study aimed to analyze the effectiveness of combination therapy with clopidogrel and aspirin among mild‐to‐moderate ischemic stroke patients treated within 72 h on the basis of a high‐intensity dose of statins. Methods In a retrospective and multicenter cohort study, acute (within 72 h of onset) mild‐to‐moderate stroke patients were divided into aspirin and clopidogrel‐aspirin groups on the basis of a high‐intensity dose of statin therapy. The primary outcome was compound vascular events during hospitalization. Cox's proportional hazards model was used to assess differences, with the study center as a random effect. Results Among the 506 patients meeting the eligibility criteria, all subjects received a high‐intensity dose of statins, including 20 mg rosuvastatin or 40 mg atorvastatin while in the hospital. In an unadjusted analysis, compound vascular events occurred in 7.2% of patients in the clopidogrel‐aspirin group compared with 13.7% of those in the aspirin group (p = 0.022). In a Cox proportional hazards regression analysis, clopidogrel‐aspirin was associated with a lower risk of compound vascular events (hazard ratio [95% CI], 0.47 [0.25–0.87]; p = 0.017) and ischemic vascular events (p = 0.008). Moderate and severe hemorrhage occurred in four patients (1.07%) in the clopidogrel‐aspirin group and three patients (2.30%) in the aspirin group (p = 0.626). Interpretation In this study based on high‐intensity statin therapy, clopidogrel‐aspirin reduced the risk of compound vascular events and did not increase the risk of hemorrhage during patients' hospitalization after mild‐to‐moderate ischemic stroke within 72 h.

Exploring Drug Prescription Patterns in the Neurology Department of a Tertiary Care Hospital: A Comprehensive Analysis

“…In terms of medication, monotherapy was the most common treatment approach, with 38.66% of patients receiving a monotherapy. This finding is consistent with the study conducted by Haimei et al, where monotherapy (45.82%) was the primary treatment modality 17 .Monotherapy was preferred over polytherapy because of minimal occurance of drug -drug interaction, adverse drug reaction, improved medication adherence also financially affordable for all patients Furthermore, 9.97% of the patient population received injections, with Inj. Dexamethasone 8mg (4%) and Inj.…”

“…However, the results of this study had shown only 25% of prescriptions used generic names, which is much lesser than the prescription pattern in other Asian countries such as Pakistan (71.6%), Nepal (59.02%), and Jordan (57.6%). [15][16][17] It must also be noted that 96.88% of generic prescribing was reported in India 25 .…”

A REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack (READAPT)

“…Lastly, READAPT patients might have presented a higher vascular risk profile than those in RCTs according to median age, and prevalence of arterial hypertension and prior vascular events. Previous real-world studies comparing subgroups of patients according to their risk profile have shown that DAPT was more effective in those at higher compared with those at lower risk 27,28 .…”

Intensive Versus Moderate Statin‐Based Therapies in Patients With Mild Ischemic Stroke: A Prospective Multicenter Cohort Study

“…In our retrospective cohort study of patients with mild stroke in China, high‐intensity statin treatment is not associated with a lower incidence of ischemic vascular events during patient hospitalization compared with moderate‐intensity statin treatment. 18 In the TST, the advantages of a lower target strategy against stroke recurrence are still not observed among Koreans after 2 years of follow‐up. 4 In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial based on non‐Asian populations, the Kaplan–Meier curves between the statin and placebo groups are separated until at least 1 year after randomization, 5 which may be related to relatively higher LDL‐C levels, less systemic exposure to atorvastatin, and a slow decrease in LDL‐C levels.…”