Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Effect of Dual versus Mono Antiplatelet Therapy on Recurrent Stroke Modulated by Activated Partial Thromboplastin Time.
First author：Xuewei Xie,Xianwei Wang
Corresponding author：Yongjun Wang
essential_information
- Person in charge：Xuewei Xie,Xianwei Wang
- Data Sources： CHANCE
- Number of papers：CHANCE20190167
- Published time：2019-04-10
2019-04-10
Published articles
Journal：European journal of neurology
Publication type: Original Contributions
IF(IF): 6.089
PMID: 30972875 Link To Pubmed Full text Download
Background And Purpose
The efficacy of dual antiplatelet treatment may be modified by many factors. We aimed 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).
Method
Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A total of 5,074 patients were categorized into 3 groups based on the aPTT distribution according to 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.
Conclusion
Dual antiplatelet therapy was superior to single antiplatelet therapy in the high or medium aPTT, but not in the low aPTT.
Main results
In the high-aPTT group (defined as ≥35.9s), 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 (24.6-35.8s), 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 (≤24.5s), 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 levels at the cutpoint of approximate 25s or below was significant (P<0.05).