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Abstract Details

Comparative effectiveness of dual antiplatelet therapy with aspirin and clopidogrel versus aspirin monotherapy in acute mild-to-moderate ischemic stroke according to the recurrent stroke risks: An analysis of 15000 patients from a nationwide, multicenter registry
Cerebrovascular Disease and Interventional Neurology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
4-020
To compare the effectiveness of the dual antiplatelet therapy with clopidogrel-aspirin (DAPT) with that of aspirin monotherapy (AM) in acute mild-to-moderate ischemic stroke considering the risk of recurrent stroke by the SPI-II score.
Magnitudes of effectiveness of DAPT for acute mild-to-moderate ischemic stroke patients according to the recurrent stroke risks have not been extensively studied.
This study is a retrospective analysis of a prospective, multicenter registry between January 2011 and July 2018. Acute (within 24h of onset), mild-to-moderate (NIHSS score ≤10), and non-cardioembolic stroke patients were identified. The SPI-II scores were retrospectively calculated and categorized into 3 groups; low (0-3), middle (4-7), and high risk (8 or more). The primary outcome event was a composite of stroke, MI, and all-cause mortality within 3m of stroke. Propensity scores using IPTW were used to adjust baseline imbalances between the DAPT and AM groups according to the SPI-II subgroups.  

Among the 15,430 patients (age, 66±13yrs; male, 62.0%), 45.1% received a DAPT and 54.9% received an AM. The primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%) (P=0.03). Weighted Cox PH analysis showed the reduced risk of 3-month vascular events in the DAPT group vs the AM group (HR 0.84 [0.78-0.92]), with no interactions with acute treatments and the SPI-II risk subgroups (Pinteraction=0.44). However, among the high risk patients of SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group.

Treatment with DAPT significantly reduced the risk of 3-month vascular events compared with AM in acute, mild-to-moderate, non-cardiogenic, ischemic stroke patients. The treatment effects of DAPT vs AM were consistent with the recurrent stroke risk subgroups by the SPI-II scores, but more substantial benefits of DAPT in the high risk subgroup.   
Authors/Disclosures
Joontae Kim, MD, PhD (Chonnam National University Hospital)
PRESENTER 		Dr. KIM has nothing to disclose.
Seung-Han Lee, MD, PhD (Chonnam National University Hospital) Dr. Lee has nothing to disclose.
No disclosure on file
No disclosure on file
Hee-Joon Bae, MD (Eulji Gen Hosp/Dept of Neuro) No disclosure on file