Treatment Strategies and Prognosis for Moderate Stroke Patients in China

Cerebrovasc Dis. 2024;53(5):547-555. doi: 10.1159/000535171. Epub 2023 Nov 18.

Abstract

Introduction: Moderate stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores of 4-10 and without intravenous thrombolysis or endovascular treatment are basically excluded from current secondary prevention trials. We aimed to explore the effectiveness of mono- versus dual-antiplatelet treatment (DAPT) strategies against subsequent stroke for these patients in a nationwide cohort.

Methods: Data were derived from the Third China National Stroke Registry (CNSR-III). In this prospective nationwide cohort, moderate ischemic stroke patients with NIHSS scores of 4-10 and without intravenous thrombolysis or endovascular treatment were included and categorized into mono- or dual-antiplatelet groups. Demographics, medical history, NIHSS score, imaging, and laboratory data were collected. The outcomes were stroke recurrence and all-cause mortality at 3 months and 1 year, respectively. Cox proportional hazards models were utilized to investigate the association of treatment strategies and prognosis.

Results: Of a total of 2,414 patients enrolled in the study, 1,633 (67.6%) received clopidogrel or aspirin, and 781 (32.4%) received DAPT. Recurrent stroke occurred in 108 (6.6%) patients of the mono-antiplatelet group and 40 (5.1%) patients of the DAPT group (adjusted hazard ratio [aHR] 0.73, 95% confidential interval [CI] 0.47-1.13, p = 0.16) at 3 months, and the rate of stroke recurrence was 10.7% in the mono-antiplatelet group and 8.6% in the DAPT group (aHR 0.81, 95% CI 0.58-1.13, p = 0.22) at 12 months. The DAPT paradigm was not significantly associated with death at 3 months (0.6% vs. 0.3%, aHR 0.28, 95% CI: 0.04-2.25) but significantly reduced the mortality at 12 months (2.3% vs. 1.0%, aHR 0.41, 95% CI: 0.17-0.98, p = 0.046).

Conclusions: In moderate stroke patients presenting within 24 h of symptom onset, the addition of clopidogrel 75 mg to aspirin might not be associated with lower risk of recurrent stroke than aspirin or clopidogrel alone.

Keywords: Aspirin; Clopidogrel; Recurrence; Stroke.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aspirin* / administration & dosage
  • Aspirin* / adverse effects
  • Aspirin* / therapeutic use
  • China / epidemiology
  • Clopidogrel* / administration & dosage
  • Clopidogrel* / adverse effects
  • Clopidogrel* / therapeutic use
  • Disability Evaluation
  • Dual Anti-Platelet Therapy* / adverse effects
  • Female
  • Humans
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / drug therapy
  • Ischemic Stroke* / mortality
  • Ischemic Stroke* / therapy
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors* / administration & dosage
  • Platelet Aggregation Inhibitors* / adverse effects
  • Platelet Aggregation Inhibitors* / therapeutic use
  • Prospective Studies
  • Recurrence*
  • Registries*
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention*
  • Severity of Illness Index
  • Stroke / diagnosis
  • Stroke / drug therapy
  • Stroke / mortality
  • Stroke / therapy
  • Time Factors
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Aspirin
  • Clopidogrel