Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Eur J Neurol. 2019 Sep;26(9):1168-e78. doi: 10.1111/ene.13961. Epub 2019 May 9.
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).
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.
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).
Dual antiplatelet therapy was superior to single antiplatelet therapy in the high or medium aPTT group but not in the low aPTT group.
双抗血小板治疗的疗效可能受到许多因素的影响。本研究旨在评估氯吡格雷联合阿司匹林与单独使用阿司匹林相比，对复发性卒中的影响是否会受到入院时激活部分凝血活酶时间（aPTT）的影响。
数据来自氯吡格雷在急性非致残性脑血管事件高危患者中的应用（CHANCE）试验。根据第 15 和 85 百分位数，将 5074 例患者分为三组，根据 aPTT 分布情况进行分组。主要终点为 90 天内任何卒中。采用 Cox 比例风险模型评估 aPTT 与抗血小板治疗对卒中风险的交互作用，并对协变量进行调整。
在高 aPTT 组（定义为≥35.9 s），氯吡格雷-阿司匹林组和阿司匹林组的卒中发生率分别为 6.7%和 11.9%（校正后危险比[HR]为 0.50；95%置信区间[CI]为 0.29-0.85）。在中 aPTT 组（24.6-35.8 s），氯吡格雷-阿司匹林组和阿司匹林组的卒中发生率分别为 7.7%和 11.8%（校正后 HR 为 0.62；95% CI 为 0.50-0.75）。此外，在低 aPTT 组（≤24.5 s），氯吡格雷-阿司匹林组和阿司匹林组的卒中发生率分别为 11.2%和 9.9%（校正后 HR 为 1.07；95% CI 为 0.65-1.62）。在大约 25 s 或以下的 aPTT 水平的截断值处，抗血小板治疗与 aPTT 水平的交互 P 值具有统计学意义（P < 0.05）。
与单独使用阿司匹林相比，在高或中 aPTT 组中，双联抗血小板治疗优于单药治疗，但在低 aPTT 组中并非如此。
