A Study on the Effectiveness of Mono and Dual Antiplatelet Therapy in Secondary Prevention of Vascular Events
Main Article Content
Abstract
The aim of the study was to determine whether addition of aspirin to clopidogrel could have a greater benefit than clopidogrel alone in the prevention of secondary vascular events in patients after TIA or ischemic stroke. Out of the total patients, 34.2 % of patients had recurrence of vascular events. 36.3 % patients reached the primary endpoint in the group receiving dual therapy compared to 20% in the monotherapy group. 31% in dual therapy group had Ischemic stroke as qualifying event compared to 5 % in monotherapy. Our study focused on the prevalence of risk factors in patients with recurrence of vascular events. Risk factors found were previous ischemic stroke in 12 % of dual therapy group and 1% in mono group. Hypertension was found in 30 % of dual group and 3 % of mono group. Diabetes was risk factor in 16% of dual therapy patients and 4% in mono group Hypercholesterolemia was found in 19% of dual group and 4 % of mono group11% of dual therapy patients and 2 % of mono therapy patients were smokers. The primary events were found to have a significant association with gender, risk factors and therapy. No bleeding complications were observed in the study population.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Centers for Disease Control and Prevention. Stroke facts. https://www.cdc.gov/stroke/facts.hmt.Accessed November 20, 2018.
Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med 2016;374(16):1533–1542. 10.1056/NEJMoa1412981 [PubMed] [CrossRef] [Google Scholar]
Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901–2906. [PubMed] [Google Scholar]
Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP. The high risk of stroke immediately after transient ischemic attack: A population-based study. Neurology. 2004;62(11):2015–2020. 10.1212/01.WNL.0000129482.70315.2F. [PubMed] [CrossRef] [Google Scholar]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3). 10.1161/STR.0000000000000158 [PubMed] [CrossRef] [Google Scholar]
CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349(9066):1641–1649. doi:S0140673697040105[pii] [PubMed] [Google Scholar]
The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet (London, England). 1997;349(9065):1569–1581. Accessed May 3, 2019. [PubMed] [Google Scholar]
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet (London, England). 1996;348(9038):1329–1339. Accessed May 3, 2019. [PubMed] [Google Scholar]
ESPRIT Study Group, Halkes PHA, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367(9523):1665–1673. 10.1016/S0140-6736(06)68734-5 [PubMed] [CrossRef] [Google Scholar]
Sacco RL, Diener H-C, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359(12):1238–1251. 10.1056/nejmoa0805002 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack for the CHANCE Investigators*. N Engl J Med. 2013;369(1):11–19. 10.1056/NEJMoa1215340 [PubMed] [CrossRef] [Google Scholar]
Wang X, Zhao X, Johnston SC, et al. Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke. Neurology. 2015;85(7):573–579. 10.1212/WNL.0000000000001844 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379(3):215–225. 10.1056/NEJMoa1800410 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Diener H-C, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331–337. 10.1016/S0140-6736(04)16721-4 [PubMed] [CrossRef] [Google Scholar]
SPS3 Investigators, Benavente OR, Hart RG, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012;367(9):817–825. 10.1056/NEJMoa1204133 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Wang C, Yi X, Zhang B, Liao D, Lin J, Chi L. Clopidogrel plus aspirin prevents early neurologic deterioration and improves 6-month outcome in patients with acute large artery atherosclerosis stroke. Clin Appl Thromb. 2015;21(5):453–461. 10.1177/10760 [PubMed] [CrossRef] [Google Scholar]
Hong K-S, Lee S-H, Kim EG, et al. Recurrent ischemic lesions after acute atherothrombotic stroke. Stroke. 2016;47(9):2323–2330. 10.1161/strokeaha.115.012293 [PubMed] [CrossRef] [Google Scholar]
N.Manichandana, V. Srilatha, B.Vijatha, R.Tulsi, Dr.Amatul Ali Sameera, Neurological Disorders And Diseases: Prevalence And Incidence In Tertiary Care Hospital.,Indo Am. J. P. Sci, 2022; 09(6). [Google Scholar]