Wang Guangyao, Yang Xiaomeng, Jing Jing, Zhao Xingquan, Liu Liping, Wang Chunxue, Wang David, Wang Anxin, Meng Xia, Wang Yongjun, Wang Yilong
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2021 Mar 29;12:631220. doi: 10.3389/fneur.2021.631220. eCollection 2021.
We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI - PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD. Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25-2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40-2.68, interaction = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI - PAD. There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI - PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.
在“高危急性非致残性脑血管事件患者的氯吡格雷治疗（CHANCE）”试验中，我们旨在研究氯吡格雷联合阿司匹林对不同类型的单一小皮质下梗死（SSSI）患者的疗效及安全性。SSSI定义为扩散加权成像（DWI）上单一病灶≤2.0 cm。根据责任动脉狭窄情况，将SSSI患者分为SSSI + 外周动脉疾病（PAD，即责任动脉疾病）组和SSSI - PAD组。疗效结局为90天随访期间的卒中复发。采用Cox比例风险模型或逻辑回归模型评估氯吡格雷联合阿司匹林与单用阿司匹林治疗效果在有或无PAD患者中的交互作用。纳入亚分析的338例SSSI患者中，105例有PAD，233例无PAD。氯吡格雷联合阿司匹林与单用阿司匹林相比，在有PAD患者中（调整后风险比[HR] 0.84；95%置信区间[CI]，0.25 - 2.75）和无PAD患者中（调整后HR 1.03；95% CI，0.40 - 2.68，交互作用 = 0.83），对任何卒中的疗效均一致。在SSSI + PAD患者中，双联抗血小板治疗组与单联抗血小板治疗组的卒中复发率无显著差异（10.9%对13.6%，P = 0.77）。无论SSSI + PAD或SSSI - PAD，氯吡格雷 - 阿司匹林组与阿司匹林组之间的出血事件数量相似。在CHANCE试验中，SSSI + PAD患者与SSSI - PAD患者相比，氯吡格雷联合阿司匹林与单用阿司匹林的疗效无显著差异。需要在其他人群中进行有足够效力的研究以进一步验证这些发现。
