@article{99d41f49c61645578e2afc62704e0654,
title = "Dual Versus Mono Antiplatelet Therapy in Large Atherosclerotic Stroke: A Retrospective Analysis of the Nationwide Multicenter Stroke Registry",
abstract = "Background and Purpose - Two large-scale randomized controlled trials of recurrent stroke prevention suggest that dual antiplatelet therapy with clopidogrel plus aspirin is beneficial for prevention of subsequent ischemic events. There is a paucity of data, however, on the efficacy or effectiveness of such an approach in the treatment of stroke patients with symptomatic large artery atherosclerotic occlusive disease. Methods - We used a multicenter stroke registry database (Clinical Research Collaboration for Stroke in Korea) to analyze acute ischemic stroke patients due to large artery atherosclerotic occlusive disease who were treated with aspirin alone or combination of clopidogrel and aspirin from May 2008 to May 2015. The results were analyzed by intention-to-treat, per-protocol, and as-treated methodologies. The primary end point was the 1-year composite outcome of stroke recurrence, myocardial infarction, and all-cause death. To balance the differences between groups, a frailty model using propensity scores and inverse probability of treatment weighting was used. Results - A total of 5934 patients with symptomatic large artery atherosclerotic occlusive disease were treated either with clopidogrel plus aspirin (n=2903, 49%) or aspirin (n=3031, 51%). The frequency of the primary outcome was 12% (n=353) in the clopidogrel-aspirin group and 14% (n=410) in the aspirin group. The hazards of the primary outcome with combination over aspirin only were significantly reduced in the per-protocol and as-treated analyses (hazard ratio, 0.71; 95% CI, 0.57-0.88; P=0.002 and hazard ratio, 0.81; 95% CI, 0.69-0.96; P=0.02, respectively), but there was borderline significance in the intention-to-treat analysis (hazard ratio, 0.86; 95% CI, 0.74-1.01; P=0.06). Combination therapy was beneficial for all-cause death in all analyses but did not reduce recurrent stroke. Conclusions - Compared with patients receiving aspirin monotherapy, the primary outcome seemed to occur less frequently in patients receiving dual antiplatelet therapy, which is explained mainly by the decrease of all-cause death. Since this is a nonrandomized, retrospective, observational study, our study should be cautiously interpreted.",
keywords = "aspirin, atherosclerosis, cerebral infarction, clopidogrel, mortality",
author = "Dohoung Kim and Park, {Jong Moo} and Kyusik Kang and Cho, {Yong Jin} and Hong, {Keun Sik} and Lee, {Kyung Bok} and Park, {Tai Hwan} and Lee, {Soo Joo} and Kim, {Jae Guk} and Han, {Moon Ku} and Kim, {Beom Joon} and Jun Lee and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Nah, {Hyun Wook} and Kim, {Dong Eog} and Ryu, {Wi Sun} and Kim, {Joon Tae} and Choi, {Kang Ho} and Choi, {Jay Chol} and Lee, {Byung Chul} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Kim, {Wook Joo} and Kwon, {Jee Hyun} and Shin, {Dong Ick} and Sohn, {Sung Il} and Hong, {Jeong Ho} and Lee, {Ji Sung} and Juneyoung Lee and Gorelick, {Philip B.} and Bae, {Hee Joon}",
note = "Funding Information: This research was supported by a fund (code 2017ER620100) by Research of Korea Centers for Disease Control and Prevention. Funding Information: Dr Hong reports receiving grants from Bayer Korea Ltd during the conduct of the study; grants from Boehringer Ingelheim, Bayer, and Ostuka Korea; grants and personal fees from Pfizer Korea, Bayer Korea, and Boehringer Ingelheim Korea; and personal fees from Sanofi Korea, Chong Kun Dang Pharm, Dong Wha Pharm, United Pharm, and Daichi Sankyo Korea outside the submitted work (modest). Dr Gorelick serves as a member of the ARRIVE trial (Aspirin to Reduce Risk of Initial Vascular Events) Steering Committee sponsored by Bayer (modest). Dr J.C. Choi is a site investigator of multicenter clinical trials or clinical studies sponsored by Boehringer Ingelheim, AstraZeneca Korea, Jeil pharmaceutical company Ltd, and ChongKeunDang Corp, and received lecture honoraria from Bristol-Myers Squibb Korea, Samjin pharmaceutical company Ltd, Bayer Korea, ChongKeunDang Corp, and Shire Korea Ltd (modest). Dr Sohn is receiving grants from the National Research Foundation of Korea (modest). Dr Bae is involved in the principal investigator, a member of steering committee, and a site investigator of multicenter clinical trials or clinical studies sponsored by Otsuka Korea, Bayer, Boehringer Ingelheim, Handok Pharmaceutical Company, SK Chemicals, Pfizer, ESAI-Korea, Daewoong Pharmaceutical Co, Ltd, Daichi Sankyo, AstraZeneca Korea, Dong-A Pharmaceutical, Yuhan Corporation, Bristol-Myers Squibb Korea, Korean Drug Co, Ltd, Servier and Shire Korea, Ltd; served as the scientific advisory board for Bayer Korea, Boehringer Ingelheim Korea, Bristol-Myers Squibb Korea, Pfizer Korea and Amgen Asia Holding Limited, served as the consultant for YuYu Pharmaceutical company, Korean Drug Co, Ltd, and Celltrion, Inc, and received lecture honoraria from AstraZeneca Korea, Bayer Korea, Bristol-Myers Squibb Korea, Coviden Korea, Esai Korea, Daichi Sankyo Korea, Sanofi-Aventis Korea, Korean Drug Co, Ltd, Shire Korea, Ltd (modest). The other authors report no conflicts.",
year = "2019",
month = may,
day = "1",
doi = "10.1161/STROKEAHA.119.024786",
language = "English",
volume = "50",
pages = "1184--1192",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "5",
}