Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke

Abstract

Background: This study aimed to assess the clinical outcome among patients with minor stroke, both with and without disabling neurologic deficits (DNDs). It sought to investigate the efficacy of antiplatelet therapy using clopidogrel-aspirin versus aspirin alone within the framework of the CHANCE (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) trial.

Methods and results: We enrolled 3725 patients with minor stroke from the CHANCE trial. Patients were divided into 2 groups: those with DNDs and those without, based on the presence or absence of DND, as determined by the baseline National Institutes of Health Stroke Scale score. The interaction between the treatment effects of antiplatelet therapy in patients with or without DNDs was analyzed using the Cox proportional hazards regression model. Of all enrolled patients, 1918 (51.5%) had DNDs, and 1807 (48.5%) did not. Patients with DNDs exhibited a higher risk of stroke recurrence at 90 days compared with those without (11.9% versus 8.5%; P=0.008). Dual antiplatelet therapy with clopidogrel and aspirin was associated with a reduced risk of recurrent stroke compared with the mono antiplatelet therapy in both patients with DND and patients without DNDs (adjusted hazard ratios, 0.74 [95% CI, 0.57-0.96] and 0.64 [95% CI, 0.46-0.88], respectively). There was no significant interaction between DNDs and antiplatelet therapy in reducing stroke recurrence (interaction P=0.634).

Conclusions: DNDs appear to correlate with an elevated risk of recurrent stroke in patients with minor stroke. Dual antiplatelet therapy demonstrates superiority over aspirin alone in reducing the risk of subsequent stroke events within 90 days in patients, regardless of the presence of DNDs.

Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00979589.

Keywords: NIH Stroke Scale; antiplatelet therapy; disabling neurologic deficits; ischemic stroke; stroke recurrence.

Figure 1. Kaplan–Meier curves for the efficacy outcome of new stroke.

Cumulative incidence of new stroke (any stroke) in patients with and without DNDs, treated with clopidogrel plus aspirin, or aspirin alone. DND indicates disabling neurologic deficit.

Figure 2. Forest plot for intention‐to‐treat analyses of the efficacy outcomes at 90 days.

Intention‐to‐treat analyses indicated no significant statistic difference on interaction between the presence of disabling neurologic deficits and the effects of clopidogrel and aspirin vs aspirin alone in the efficacy outcomes (interaction P value >0.05 in all components). ASA indicates aspirin; CLP, clopidogrel; HR, hazard ratio; and mRS, modified Rankin Scale.

Figure 3. Functional outcomes at 90 days by mRS score of patients with and without disabling neurologic deficits.

A, Distribution of 90‐d mRS score among patients with or without disabling neurologic deficits. B, Distribution of 90‐d mRS score in different antiplatelet therapy of patients without disabling neurologic deficits. C, Distribution of 90‐d mRS score in different antiplatelet therapy of patients with disabling neurologic deficits. mRS indicates modified Rankin Scale.