Ma Yan, Liu Ying, Xu Jie, Wang Yilong, Wang Yongjun, Du Fenghe
Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ther Clin Risk Manag. 2018 May 8;14:861-870. doi: 10.2147/TCRM.S156694. eCollection 2018.
To assess whether bodyweight influences the efficacy and safety of dual antiplatelet therapy (DAT) in male patients with minor stroke or transient ischemic attack patients.
All 3,420 male participants coming from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial were divided into 3 groups based on bodyweight (<65 kg, 65-75 kg, and ≥75 kg). The stroke outcomes included stroke recurrence, combined vascular events, and bleeding events during 90 days of follow-up. The interaction of the treatment effects of DAT among patients with different bodyweight was assessed by Cox proportional hazards models.
DAT is superior to mono antiplatelet therapy (MAT) for reducing stroke recurrence among patients with weight <65 kg (5.0% vs 11.7%; hazard ratio [HR], 0.41; 95% CI: 0.22-0.76) and 65-75 kg (6.7% vs 10.8%, HR, 0.62; 95% CI: 0.43-0.89). However, no significant difference was found in stroke recurrence between DAT and MAT in patients with weight ≥75 kg (9.4% vs 11.6%; HR, 0.80; 95% CI: 0.58-1.10). A significant interaction was observed between weight and antiplatelet therapy on stroke recurrence (<0.05). Similar result was found for combined vascular events. More bleeding events were found in DAT group among patients with <65 kg (3.7% vs 2.2%), but with no significant difference.
DAT does not show benefit in patients with higher weight, compared with MAT. Bleeding events found in the DAT group were not more than the MAT group among patients with lower weight.
URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00979589.
评估体重是否会影响轻度卒中或短暂性脑缺血发作男性患者双联抗血小板治疗（DAT）的疗效和安全性。
来自“急性非致残性脑血管事件高危患者的氯吡格雷”试验的所有3420名男性参与者，根据体重分为3组（<65kg、65 - 75kg和≥75kg）。卒中结局包括随访90天期间的卒中复发、合并血管事件和出血事件。采用Cox比例风险模型评估不同体重患者中DAT治疗效果的相互作用。
在体重<65kg（5.0%对11.7%；风险比[HR]，0.41；95%CI：0.22 - 0.76）和65 - 75kg（6.7%对10.8%，HR，0.62；95%CI：0.43 - 0.89）的患者中，DAT在降低卒中复发方面优于单联抗血小板治疗（MAT）。然而，在体重≥75kg的患者中，DAT和MAT在卒中复发方面未发现显著差异（9.4%对11.6%；HR，0.80；95%CI：0.58 - 1.10）。在体重和抗血小板治疗对卒中复发的影响之间观察到显著的相互作用（<0.05）。合并血管事件也得到了类似结果。在体重<65kg的患者中，DAT组的出血事件更多（3.7%对2.2%），但无显著差异。
与MAT相比，DAT在体重较高的患者中未显示出益处。在体重较低的患者中，DAT组发现的出血事件并不比MAT组多。
