The effectiveness and safety of dual antiplatelet therapy in ischemic cerebrovascular disease with intracranial and extracranial arteriostenosis in Chinese patients

Abstract

Background:There are limited data on the effect of dual antiplatelet treatment with clopidogrel plus aspirin in patients with ischemic cerebrovascular disease and intracranial and extracranial arteriostenosis. The aim of our study was to evaluate the efficacy and safety of aspirin plus clopidogrel in the treatment of ischemic cerebrovascular disease with intracranial and extracranial arteriostenosis.Methods:Patients with clinically evident acute cerebral infarction or transient ischemic attack combined with intracranial and extracranial arteriostenosis (greater than 50%) who were unsuitable or reluctance to perform stent implantation were enrolled in this study. We randomly assigned these patients to receive clopidogrel (75 or 50 mg) plus aspirin (100 mg) or aspirin (100 mg) once daily through 90 days, and followed them for 90 days. We examined the main endpoints including the recurrence of stroke, death from cardiovascular causes, and bleeding events.Results:In all, 200 patients were recruited and followed for 90 days. Ischemic stroke occurred in 6 patients (9.1%) treated with 50 mg clopidogrel and aspirin, 6 patients (9.1%) receiving 75 mg clopidogrel and aspirin, whereas 19 patients (27.9%) in the aspirin group (aspirin alone vs copidogrel 50 mg plus aspirin; 95% confidence intervals 1.704–23.779, P < 0.05; aspirin alone vs copidogrel 75 mg plus aspirin; 95% confidence intervals 1.190–13.240, P < 0.05). There were more hemorrhagic events among recipients (3 patients [2.3%]) in the copidogrel plus aspirin group than aspirin recipients (0 patient [0%]), including 1 subcutaneous hemorrhage in the group of 50 mg clopidogrel and aspirin, doubling the number of nasal and gum bleeding in the group of 75 mg clopidogrel and aspirin (P > 0.05). No intracranial hemorrhage and gastro-intestinal hemorrhage occurred in these 3 groups.Conclusion:Accordingly, 50 mg clopidogrel plus aspirin, and 75 mg clopidogrel plus aspirin were all superior to aspirin alone as stroke prevention in patients with cerebral infarction or transient ischemic attack combined with intracranial and extracranial arteriostenosis. The effect of secondary stroke prevention was similar between 50 mg clopidogrel plus aspirin and 75 mg clopidogrel plus aspirin. The therapy of 75 mg clopidogrel plus aspirin resulted in a worrisome tread in bleeding events.

Current Views on Antithrombotic Therapy in Non-Cardioembolic Stroke

“…Вместе с тем обнаружение признаков воз-можной эффективности раннего назначения комбинированной терапии послужило основой следующих исследований. Эффекты ранней и краткосрочной двойной терапии АСК и клопи-догрелом у пациентов с острым неинвалидизи-рующим ишемическим инсультом/ТИА, развив-шимся на фоне экстра-и интракраниальных стенозов, были оценены в рандомизированном контролируемом сравнительном исследовании, выполненном в Китае [25]. В группе больных, получавших клопидогрел 50 или 75 мг в сочета-нии АСК 100 мг, по сравнению с монотерапией АСК 100 мг 1 раз в день было отмечено сущест-венно меньшее число повторных инсультов: 9,1 против 27,9% пациентов.…”

“…При этом в группах комбинированной терапии зарегистрированы 3 случая геморрагических осложнений: 1 под-кожное кровоизлияние в группе клопидогрела 50 мг и 2 назальных кровотечения в группе кло-пидогрела 75 мг. Среди больных, получавших монотерапию АСК, кровотечений отмечено не было [25].…”

Repurposing of Approved Cardiovascular Drugs against Ischemic Cerebrovascular Disease by Disease–Disease Associated Network-Assisted Prediction

“…31) Disease are viewed as perturbations of a set of coordinated functional gene groups, researchers introduced a drug-disease proximity approach that quantifies the interplay between drugs targets and diseases proteins, and the network-based proximity were applied to predict novel drug-disease associations (drug repurposing and the detection of adverse effects). 32) For ischemic cerebrovascular disease (ICD) and cardiovascular diseases (CVD), following the ICD and CVD diseasedisease network analysis, the shared genetics or pathways are especially interesting for understanding exactly how the aetiology of two diseases overlap, which can be beneficial for drug repurposing. Vascular protection is a novel strategy for improving stroke outcome, 4) and vascular function is critical to both CVD and ICD.…”

Protective Effect of Ethanolic Extract From the Root of Argyreia Speciosa Against Global Cerebral Ischemic Reperfusion Injury in Rats

“…According to WHO and the results of various clinical investigation reveals that synthesized drugs remains usually challenging to attain desirable results because of severe adverse effects and single therapeutic target 9,10 . Hence, it is required to investigate more efficient drug with minimal adverse effects to treat the cerebral ischemiareperfusion, induced injury.…”