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Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy.

Publication ,  Journal Article
Wang, X; Zhao, X; Johnston, SC; Xian, Y; Hu, B; Wang, C; Wang, D; Liu, L; Li, H; Fang, J; Meng, X; Wang, A; Wang, Y; Wang, Y; CHANCE investigators,
Published in: Neurology
August 18, 2015

OBJECTIVE: We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA. METHODS: Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less. RESULTS: Poor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups. CONCLUSIONS: In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%-3.42%).

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Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

August 18, 2015

Volume

85

Issue

7

Start / End Page

573 / 579

Location

United States

Related Subject Headings

  • Ticlopidine
  • Stroke
  • Quality of Life
  • Platelet Aggregation Inhibitors
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
  • Humans
 

Citation

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Wang, X., Zhao, X., Johnston, S. C., Xian, Y., Hu, B., Wang, C., … CHANCE investigators, . (2015). Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy. Neurology, 85(7), 573–579. https://doi.org/10.1212/WNL.0000000000001844
Wang, Xianwei, Xingquan Zhao, S Claiborne Johnston, Ying Xian, Bo Hu, Chunxue Wang, David Wang, et al. “Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy.Neurology 85, no. 7 (August 18, 2015): 573–79. https://doi.org/10.1212/WNL.0000000000001844.
Wang X, Zhao X, Johnston SC, Xian Y, Hu B, Wang C, et al. Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy. Neurology. 2015 Aug 18;85(7):573–9.
Wang, Xianwei, et al. “Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy.Neurology, vol. 85, no. 7, Aug. 2015, pp. 573–79. Pubmed, doi:10.1212/WNL.0000000000001844.
Wang X, Zhao X, Johnston SC, Xian Y, Hu B, Wang C, Wang D, Liu L, Li H, Fang J, Meng X, Wang A, Wang Y, CHANCE investigators. Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy. Neurology. 2015 Aug 18;85(7):573–579.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

August 18, 2015

Volume

85

Issue

7

Start / End Page

573 / 579

Location

United States

Related Subject Headings

  • Ticlopidine
  • Stroke
  • Quality of Life
  • Platelet Aggregation Inhibitors
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
  • Humans