Evaluation of the efficacy of aspirin combined with low doses of clopidogrel in the treatment of symptomatic intracranial artery stenosis in the elderly

Abstract

Background Symptomatic intracranial artery stenosis (ICAS) is a significant worldwide economic and great threat to public health. Currently, little is known about the accurate status of the efficient and tolerable dose of dual antiplatelet therapy (DAPT) as the mainstay treatment for ICAS. The aim of this study is to evaluate the efficacy and safety of aspirin plus clopidogrel in small doses for the treatment of symptomatic ICAS in the elderly. Methods This research included 142 older adults with symptomatic ICAS who were enrolled between April 2013 and April 2018. They were split into two groups: 73 patients in the lower dose group who received 75 mg of aspirin daily and 50 mg of clopidogrel daily, and 69 patients in the usual group who received 100 mg of aspirin daily and 75 mg of clopidogrel daily. Results Ages of 142 patients ranged from 60 to 81, with a mean of 70.9 ± 6.4. 58 participants were with IS and 84 were with TIA. A total of 132 patients were followed up. The low-dose group had a lower recurrence risk of ischemic stroke (IS) or transient ischaemic attack (TIA) than the conventional group at 1-year and 2-year follow-up, as well as a reduced frequency of adverse events and gastrointestinal injury (P < 0.05). Furthermore, after the 1-year follow-up, patients with severe symptomatic ICAS had a greater recurrence risk of IS and TIA than patients with mild symptomatic ICAS in both groups (P > 0.05). Conclusion The efficacy and safety of low-dose aspirin combined with clopidogrel were significantly better than those of ordinary dose within 24 months in elderly patients with symptomatic ICAS. However, the small size of this study limits the validity of the results.