Effect of dual antiplatelet on recurrent stroke in minor stroke or TIA depends on bodyweight
Authors Ma Y, Liu Y, Xu J, Wang YL, Wang YJ, Du FH
Received 10 November 2017
Accepted for publication 29 December 2017
Published 8 May 2018 Volume 2018:14 Pages 861—870
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Yan Ma,1 Ying Liu,2–5 Jie Xu,2–5 Yilong Wang,2–5 Yongjun Wang,2–5 Fenghe Du1
1Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; 3China National Clinical Research Center for Neurological Diseases, Beijing, China; 4Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
Objective: To assess whether bodyweight influences the efficacy and safety of dual antiplatelet therapy (DAT) in male patients with minor stroke or transient ischemic attack patients.
Materials and methods: All 3,420 male participants coming from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial were divided into 3 groups based on bodyweight (<65 kg, 65–75 kg, and ≥75 kg). The stroke outcomes included stroke recurrence, combined vascular events, and bleeding events during 90 days of follow-up. The interaction of the treatment effects of DAT among patients with different bodyweight was assessed by Cox proportional hazards models.
Results: DAT is superior to mono antiplatelet therapy (MAT) for reducing stroke recurrence among patients with weight <65 kg (5.0% vs 11.7%; hazard ratio [HR], 0.41; 95% CI: 0.22–0.76) and 65–75 kg (6.7% vs 10.8%, HR, 0.62; 95% CI: 0.43–0.89). However, no significant difference was found in stroke recurrence between DAT and MAT in patients with weight ≥75 kg (9.4% vs 11.6%; HR, 0.80; 95% CI: 0.58–1.10). A significant interaction was observed between weight and antiplatelet therapy on stroke recurrence (p<0.05). Similar result was found for combined vascular events. More bleeding events were found in DAT group among patients with weight <65 kg (3.7% vs 2.2%), but with no significant difference.
Conclusion: DAT does not show benefit in patients with higher weight, compared with MAT. Bleeding events found in the DAT group were not more than the MAT group among patients with lower weight.
Clinical trial registration: URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00979589.
Keywords: bodyweight, dual antiplatelet therapy, ischemic stroke, outcomes, TIA
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