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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Xia, Haiqin Zeng, Jinsheng Li, Yansheng Johnston, S. Claiborne Dong, Qiang Li, Hao Liu, Liping Jia, Jianping Zhao, Xingquan Wang, Yilong Meng, Xia Xu, Anding Wang, Zhimin Cui, Liying Wang, David Wang, Chen Wang, Chunxue Wang, Yongjun |
| Description | Author Affiliation: Wang Y ( Beijing Tiantan Hospital, Capital Medical University, Beijing, China. yongjunwang1962@gmail.com) |
| Abstract | BACKGROUND: Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone. METHODS: In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-to-treat analysis. Treatment differences were assessed with the use of a Cox proportional-hazards model, with study center as a random effect. RESULTS: Stroke occurred in 8.2% of patients in the clopidogrel-aspirin group, as compared with 11.7% of those in the aspirin group (hazard ratio, 0.68; 95% confidence interval, 0.57 to 0.81; P<0.001). Moderate or severe hemorrhage occurred in seven patients (0.3%) in the clopidogrel-aspirin group and in eight (0.3%) in the aspirin group (P=0.73); the rate of hemorrhagic stroke was 0.3% in each group. CONCLUSIONS: Among patients with TIA or minor stroke who can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first 90 days and does not increase the risk of hemorrhage. (Funded by the Ministry of Science and Technology of the People's Republic of China; CHANCE ClinicalTrials.gov number, NCT00979589.). |
| ISSN | 00284793 |
| Issue Number | 1 |
| Volume Number | 369 |
| e-ISSN | 15334406 |
| Journal | New England Journal of Medicine |
| Language | English |
| Publisher | Massachusetts Medical Society (United States) |
| Publisher Date | 2013-07-04 |
| Publisher Place | United States |
| Access Restriction | Subscribed |
| Subject Keyword | Ischemic Attack, Transient Drug Therapy Platelet Aggregation Inhibitors Therapeutic Use Stroke Ticlopidine Analogs & Derivatives Aged Aspirin Adverse Effects Disease-Free Survival Double-Blind Method Drug Therapy, Combination Female Hemorrhage Chemically Induced Humans Male Middle Aged Proportional Hazards Models Secondary Prevention Prevention & Control Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Medicine |
| Content Type | Text |
| Resource Type | Article |
| Subject | Medicine |
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