The Outcome of Acute Ischemic Stroke in Sudanese patients on Dual Anti-platelet Therapy Clopidogrel and Aspirin vs. Aspirin using modified Ranking scale at the National Centre for Neurological Science

Abstract

Background: Stroke or cerebrovascular accident (CVA) is defined as the sudden occurrence of a focal, non-conclusive neurological deficit; with variable consequences, ranging from subtle to very severe disabilities, depending on the area of the brain involved and the nature of the attack. Anti-platelet therapy such as aspirin and clopidogrel is used for both management and prevention of stroke, it reduced the incidence of stroke in patients at high risk for atherosclerosis and in those with known symptomatic cerebrovascular disease. Objective: To assess the difference in the outcome of dual anti platelet therapy clopidogrel and aspirin vs. aspirin, in acute ischemic stroke using Modified Ranking scale. Methods: A prospective Cohort study was conducted at the National center of neurological Science within the period of Jan-December 2018. Data collected through structural closed ended questionnaire. Data entered, cleaned, analyzed using SPSS version 25.0.The change in the outcome using Modified Ranking Scale after treatment was done. Results: This study covered 92 study participants, 75% were above 60 years of age, with ratio male: female. 1.2: 1. 45.6% were housewives while 95.1%were from rural residential areas. 93.5% complained of weakness ,dysphasia 60.9%, loss of consciousness 19.6% and swallowing difficulties among 15.2%. Investigations showed 54.3% had middle cerebral artery occlusion, 18.5% had lacunar infarcts, 10.9%had vertebral-and basilar artery occlusion while only 1.1% had cavernous sinus thrombosis. 9.8% had abnormal complete blood count results, 12% had abnormal renal functions, 16.3% had abnormal random blood glucose, and 28.3% had abnormal urine analysis results. In this study, cross tabulation was done to assess the possible association between the type of treatment given in presentation with the change in Modified Rankin Scale using t paired statistical test. The analysis found that there was a significant reduction in Modified Rankin Scale from 4.2 to 3.2 (p value<0.001) among all study participants. The difference in Modified Rankin Scale was higher among patients who used aspirin with clopidogrel from 4.1 to 2.3compared to patients who used aspirin only from 4.2 to 3.5 with p value less than 0.05. Conclusion: The study concluded there is a significant improvement in the outcome of stroke during follow up using modified Ranking Scale in patients who used dual anti platelet vs. aspirin only. The combination therapy is superior to aspirin alone regarding the management, prevention and the outcome. Furthermore, it does not increase the risks of haemorrhage.