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Aspirin plus clopidogrel in acute minor ischaemic stroke or transient ischaemic attack is superior to aspirin alone for stroke risk reduction: CHANCE trial
Commentary on: Wang Y, Wang Y, Zhao X, et al.. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19. Context Combination therapy with aspirin added to clopidogrel has had a disappointing record in the prevention of recurrent stroke. The management of atherothrombosis with clopidogrel in high-risk patients (MATCH)1 and the secondary prevention of small subcortical strokes (SPS3)2 randomised controlled trials (RCTs) showed that combination therapy was not more effective than clopidogrel or aspirin alone, but was associated with two to three times the risk of major or ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Gorelick, P. B., Farooq, M. U. Tags: Smoking and tobacco, Clinical trials (epidemiology), Genetics, Stroke, Hypertension, Diabetes, Health education, Smoking Therapeutics Source Type: research

Meta-analysis finds benefit for dual antiplatelet therapy but limitations preclude changing standard mono antiplatelet therapy approach for acute non-cardioembolic ischaemic stroke or transient ischaemic attack
Commentary on: Wong KSL, Wang Y, Leng X, et al.. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack. An updated systematic review and meta-analysis. Circulation 2013;128:1656–66. Context Current guidelines recommend aspirin, aspirin plus clopidogrel or aspirin plus extended-release dipyridamole for treatment of acute ischaemic stroke (IS) or transient ischaemic attack (TIA) to prevent recurrent stroke, myocardial infarction and cardiovascular death.1 The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial ra...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Aronow, W. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease Therapeutics Source Type: research

Dual antiplatelet therapy in recurrent stroke prevention: do the benefits outweigh the risks?
This study assessed seven randomised controlled trials, comprising 39 574 patients and comparing dual versus single antiplatelet therapies. Medications used included aspirin (50–325 mg daily), clopidogrel (75 mg daily), aspirin plus dipyridamole (50/400 mg daily) and ticlopidine (100 mg daily). Patients had a history of ischaemic stroke (three trials) or TIA (four...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Stroke Therapeutics Source Type: research

The correlation between recurrent risk and CYP2C19 gene polymorphisms in patients with ischemic stroke treated with clopidogrel for prevention
Conclusion: For patients with IS treated with clopidogrel regularly for secondary prevention, poor metabolizer, and intermediate metabolizer patients had higher risk of recurrent stroke comparing with extensive metabolize ones. Carrying CYP2C19 LOF allele is an independent risk factor of stroke recurrence in patients with IS.
Source: Medicine - March 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Risk-Benefit Profile of Long-Term Dual- Versus Single-Antiplatelet Therapy Among Patients With Ischemic Stroke: A Systematic Review and Meta-analysis.
CONCLUSION: Compared with monotherapy, dual-antiplatelet therapy lasting more than 1 year after an index ischemic stroke or transient ischemic attack is not associated with a greater reduction in overall recurrent stroke risk. However, long-term dual-antiplatelet therapy is linked to higher risk for ICH than clopidogrel monotherapy in this patient population. PRIMARY FUNDING SOURCE: Chang Gung Memorial Hospital. PMID: 24081287 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - October 1, 2013 Category: Internal Medicine Authors: Lee M, Saver JL, Hong KS, Rao NM, Wu YL, Ovbiagele B Tags: Ann Intern Med Source Type: research

Efficacy and safety of clopidogrel and/or aspirin for ischemic stroke/transient ischemic attack: An overview of systematic reviews and meta-analysis
Conclusions: High-quality evidence suggested that clopidogrel plus aspirin was more efficient than monotherapy, although the risk for hemorrhagic stroke was relatively higher in combined therapy regimens lasting>1 month.
Source: Medicine - December 17, 2021 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis
CONCLUSIONS: Early administration of P2Y12 inhibitors plus aspirin in patients with acute non-cardioembolic minor ischemic stroke or TIA reduced the incidence of ischemic stroke recurrence, impacting more significantly than the increased bleeding risk and influencing patients' quality of life by reducing disabling stroke.PMID:35331593 | DOI:10.1016/j.ejim.2022.03.017
Source: European Journal of Internal Medicine - March 25, 2022 Category: Internal Medicine Authors: Fulvio Pomero Eleonora Galli Marta Bellesini Lorenzo Maroni Alessandro Squizzato Source Type: research

Risk of stroke in CYP2C19 LoF polymorphism carrier coronary artery disease patients undergoing clopidogrel therapy: An ethnicity-based updated meta-analysis
CONCLUSION: Our meta-analysis confirmed that the presence of CYP2C19 LoF alleles increases the risk of stroke and composite events recurrence in the worldwide population, especially in Asians undergoing clopidogrel treatment. Alternative antiplatelet therapy should be investigated thoroughly for the intermediate and poor metabolizers.PMID:34092486 | DOI:10.1016/j.ejim.2021.05.022
Source: European Journal of Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Sarah Jafrin Nura Ershad Naznin Md Sharif Reza Md Abdul Aziz Mohammad Safiqul Islam Source Type: research

Efficacy and safety of CYP2C19 genotype in stroke or transient ischemic attack patients treated with clopidogrel monotherapy or clopidogrel plus aspirin: Protocol for a systemic review and meta-analysis
Conclusions: The results will bring about vigorous evidence in this issue and guide both clinical decision-making and future research.
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research

Ticagrelor-Aspirin Versus Clopidogrel-Aspirin Among < em > CYP2C19 < /em > Loss-of-Function Carriers With Minor Stroke or Transient Ischemic Attack in Relation to Renal Function: A Post Hoc Analysis of the CHANCE-2 Trial
CONCLUSION: Patients with normal, rather than impaired, renal function received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin.PRIMARY FUNDING SOURCE: Ministry of Science and Technology of the People's Republic of China.PMID:36315949 | DOI:10.7326/M22-1667
Source: Annals of Internal Medicine - October 31, 2022 Category: Internal Medicine Authors: Anxin Wang Xuewei Xie Xue Tian S Claiborne Johnston Hao Li Philip M Bath Yingting Zuo Jing Jing Jinxi Lin Yilong Wang Xingquan Zhao Zixiao Li Yong Jiang Liping Liu Xia Meng Yongjun Wang Source Type: research

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