Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time.

Journal Article

BACKGROUND AND PURPOSE: The efficacy of dual antiplatelet treatment may be modified by many factors. The aim was to assess whether the effect of clopidogrel plus aspirin versus aspirin alone on recurrent stroke would be affected by admission activated partial thromboplastin time (aPTT). METHODS: Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A total of 5074 patients were categorized into three groups based on the aPTT distribution according to the 15th and 85th percentile. The primary outcome was any stroke within 90 days. The interaction of aPTT with antiplatelet therapy on stroke risk was assessed with a Cox proportional hazards model with adjustment for covariates. RESULTS: In the high aPTT group (defined as ≥35.9 s), stroke occurred in 6.7% of patients in the clopidogrel-aspirin arm and 11.9% in the aspirin arm [adjusted hazard ratio (HR) 0.50; 95% confidence interval (CI) 0.29-0.85]. In the medium aPTT group (24.6-35.8 s), stroke occurred in 7.7% of patients in the clopidogrel-aspirin arm and 11.8% in the aspirin arm (adjusted HR 0.62; 95% CI 0.50-0.75). Furthermore, in the low aPTT group (≤24.5 s), stroke occurred in 11.2% of patients in the clopidogrel-aspirin arm and 9.9% in the aspirin arm (adjusted HR 1.07; 95% CI 0.65-1.62). The interaction P value of antiplatelet therapy with aPTT level at the cut-point of approximately 25 s or below was significant (P < 0.05). CONCLUSIONS: Dual antiplatelet therapy was superior to single antiplatelet therapy in the high or medium aPTT group but not in the low aPTT group.

Full Text

Duke Authors

Cited Authors

  • Xie, X; Wang, X; Laskowitz, DT; Zhao, X; Miao, Z; Liu, L; Li, H; Meng, X; Wang, Y; CHANCE investigators,

Published Date

  • September 2019

Published In

Volume / Issue

  • 26 / 9

Start / End Page

  • 1168 - 1e78

PubMed ID

  • 30972875

Pubmed Central ID

  • 30972875

Electronic International Standard Serial Number (EISSN)

  • 1468-1331

Digital Object Identifier (DOI)

  • 10.1111/ene.13961

Language

  • eng

Conference Location

  • England