Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke: A Nationwide, Multicenter Registry-Based Study

Joon Tae Kim, Man Seok Park, Kang Ho Choi, Ki Hyun Cho, Beom Joon Kim, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae Kwan Cha, Dae Hyun Kim, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Jun Lee, Keun Sik Hong, Yong Jin Cho, Hong Kyun Park, Byung Chul Lee, Kyung Ho YuMi Sun Oh, Dong Eog Kim, Wi Sun Ryu, Jay Chol Choi, Jee Hyun Kwon, Wook Joo Kim, Dong Ick Shin, Sung Il Sohn, Jeong Ho Hong, Ji Sung Lee, Juneyoung Lee, Hee Joon Bae

Research output: Contribution to journalArticle

Abstract

Background and Purpose- This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods- Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4-15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results- Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9% versus 22.6%, P=0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3% versus 20.1%, P=0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4% versus 4.9%, P=0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95% CI, 0.79-1.04) but did reduce the risk of all-cause mortality (0.69; 0.49-0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12-15). Conclusions- Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.

Original languageEnglish
Pages (from-to)3147-3155
Number of pages9
JournalStroke
Volume50
Issue number11
DOIs
Publication statusPublished - 2019 Nov 1

Keywords

  • aspirin
  • clopidogrel
  • myocardial infarction
  • propensity score
  • proportional hazards models

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke : A Nationwide, Multicenter Registry-Based Study. / Kim, Joon Tae; Park, Man Seok; Choi, Kang Ho; Cho, Ki Hyun; Kim, Beom Joon; Park, Jong Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae Kwan; Kim, Dae Hyun; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun Sik; Cho, Yong Jin; Park, Hong Kyun; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Kim, Dong Eog; Ryu, Wi Sun; Choi, Jay Chol; Kwon, Jee Hyun; Kim, Wook Joo; Shin, Dong Ick; Sohn, Sung Il; Hong, Jeong Ho; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee Joon.

In: Stroke, Vol. 50, No. 11, 01.11.2019, p. 3147-3155.

Research output: Contribution to journalArticle

Kim, JT, Park, MS, Choi, KH, Cho, KH, Kim, BJ, Park, JM, Kang, K, Lee, SJ, Kim, JG, Cha, JK, Kim, DH, Park, TH, Park, SS, Lee, KB, Lee, J, Hong, KS, Cho, YJ, Park, HK, Lee, BC, Yu, KH, Oh, MS, Kim, DE, Ryu, WS, Choi, JC, Kwon, JH, Kim, WJ, Shin, DI, Sohn, SI, Hong, JH, Lee, JS, Lee, J & Bae, HJ 2019, 'Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke: A Nationwide, Multicenter Registry-Based Study', Stroke, vol. 50, no. 11, pp. 3147-3155. https://doi.org/10.1161/STROKEAHA.119.026044
Kim, Joon Tae ; Park, Man Seok ; Choi, Kang Ho ; Cho, Ki Hyun ; Kim, Beom Joon ; Park, Jong Moo ; Kang, Kyusik ; Lee, Soo Joo ; Kim, Jae Guk ; Cha, Jae Kwan ; Kim, Dae Hyun ; Park, Tai Hwan ; Park, Sang Soon ; Lee, Kyung Bok ; Lee, Jun ; Hong, Keun Sik ; Cho, Yong Jin ; Park, Hong Kyun ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Kim, Dong Eog ; Ryu, Wi Sun ; Choi, Jay Chol ; Kwon, Jee Hyun ; Kim, Wook Joo ; Shin, Dong Ick ; Sohn, Sung Il ; Hong, Jeong Ho ; Lee, Ji Sung ; Lee, Juneyoung ; Bae, Hee Joon. / Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke : A Nationwide, Multicenter Registry-Based Study. In: Stroke. 2019 ; Vol. 50, No. 11. pp. 3147-3155.
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abstract = "Background and Purpose- This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods- Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4-15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results- Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7{\%}), 52.5{\%} (n=2340) received AM, and 47.5{\%} (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9{\%} versus 22.6{\%}, P=0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3{\%} versus 20.1{\%}, P=0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4{\%} versus 4.9{\%}, P=0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95{\%} CI, 0.79-1.04) but did reduce the risk of all-cause mortality (0.69; 0.49-0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12-15). Conclusions- Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.",
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TY - JOUR

T1 - Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Acute, Nonminor Stroke

T2 - A Nationwide, Multicenter Registry-Based Study

AU - Kim, Joon Tae

AU - Park, Man Seok

AU - Choi, Kang Ho

AU - Cho, Ki Hyun

AU - Kim, Beom Joon

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Soo Joo

AU - Kim, Jae Guk

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Lee, Kyung Bok

AU - Lee, Jun

AU - Hong, Keun Sik

AU - Cho, Yong Jin

AU - Park, Hong Kyun

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Choi, Jay Chol

AU - Kwon, Jee Hyun

AU - Kim, Wook Joo

AU - Shin, Dong Ick

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Lee, Ji Sung

AU - Lee, Juneyoung

AU - Bae, Hee Joon

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background and Purpose- This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods- Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4-15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results- Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9% versus 22.6%, P=0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3% versus 20.1%, P=0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4% versus 4.9%, P=0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95% CI, 0.79-1.04) but did reduce the risk of all-cause mortality (0.69; 0.49-0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12-15). Conclusions- Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.

AB - Background and Purpose- This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods- Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4-15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results- Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9% versus 22.6%, P=0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3% versus 20.1%, P=0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4% versus 4.9%, P=0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95% CI, 0.79-1.04) but did reduce the risk of all-cause mortality (0.69; 0.49-0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12-15). Conclusions- Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.

KW - aspirin

KW - clopidogrel

KW - myocardial infarction

KW - propensity score

KW - proportional hazards models

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