Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke

作者：Hui-Sheng Chen, Hui-Sheng Chen, Yu Cui, Xinhong Wang, Yu-Tong Ma, Jing Han, Ying-Jie Duan, Jiang Lu, Liying Shen, Yong Liang, Hui Wang, Hui Wang, Yong Zhao, Jin-Tao Zhang, Yulin Song, Xiao-Mei He, Run-Hui Li, Dingbo Tao, Jing Li, Shu-Man Huang, Ni Wang, Mei Hong, Chong Meng, Wei Zhang, Duo-Lao Wang, Thanh N. Nguyen, ATAMIS investigators, Shao-Yuan Chen, Li-Hong Zhao, Hong-Bo Xiao, Ying Hai, Ying Hai, Zhonglian He, Lian-Qiang Wang, Lian-Qiang Wang, Ping-Kang Pan, Dongqun Li, Yu-Tao Zhang, Dong-Yu Wang, Jingyu Li, Hongli Zhang, Xiaofeng Qiu, Fusheng Bai, Xuhai Gong, Jun Xu, Cheng-Guang Song, Zhi-Mei Yuan, Yan Du, Ping Zhang, Bao-Ying Sheng, Xin-Chen Zhu, Xin-Chen Zhu, Xiao-Hong Song, Yajun Liu, Yanqin Guo, Hui-Ru Chen, Hui-Ru Chen, Yongzhong Lin, Wei-Shu Xue, Zhao-Min Meng, Liyan Jiang, Qinghua Zhang, Hui-Min Liu, Zhong-Xin Xu, Chuan-Yu Liu, Ren-Lin Zou, Chun-Gang Zhao, Hui Li, Shuang-Yan Zhang, Z Q Wang, Ya-Fen Wei, Xuerong Qiu, Changhao Jiang · 发表于：JAMA Neurology · 年份：2024 · DOI：10.1001/jamaneurol.2024.0146 · 被引用次数：84 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research

Importance: Dual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking. Objective: To evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Design, Setting, and Participants: This was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome. Interventions: Within 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio. Main Outcomes and Measures: The primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified i...