- Among patients with minor stroke or high-risk transient ischaemic attack (TIA), discontinuing dual clopidogrel (Plavix)-aspirin antiplatelet therapy within 21 days may maximise benefit while minimising harms.
Why this matters
- Optimal duration of dual antiplatelet therapy is unknown.
- Vs aspirin alone, clopidogrel-aspirin reduced 90-day major ischemic events (6.5% vs 9.1%; HR, 0.70; P<.001>
- Significant during 0-21 days (5.2% vs 7.8%; HR, 0.66; P<.001>
- Not significant during 22-90 days (1.4% vs 1.5%; HR, 0.94; P=.72).
- Pooled analysis of individual patient data from randomised controlled trials, clopidogrel-aspirin vs aspirin, started 12-24 hours after minor stroke/high-risk TIA for secondary prevention:
- Main outcomes: major ischaemic events (ischaemic stroke, myocardial infarction, fatal ischaemic vascular events), major haemorrhage.
- Funding: Ministry of Science and Technology of People’s Republic of China; National Institute of Neurological Disorders and Stroke; Sanofi; others.
- Differing trial designs.
- Therapy limited to 21 days in CHANCE.
- Risk-benefit profile not assessed by stroke/TIA mechanism.
- Statistical analysis not preplanned.