Effect of dual antiplatelet on recurrent stroke in minor stroke or TIA depends on bodyweight

Abstract

Objective

To assess whether bodyweight influences the efficacy and safety of dual antiplatelet therapy (DAT) in male patients with minor stroke or transient ischemic attack patients.

Materials and methods

All 3,420 male participants coming from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial were divided into 3 groups based on bodyweight (<65 kg, 65–75 kg, and ≥75 kg). The stroke outcomes included stroke recurrence, combined vascular events, and bleeding events during 90 days of follow-up. The interaction of the treatment effects of DAT among patients with different bodyweight was assessed by Cox proportional hazards models.

Results

DAT is superior to mono antiplatelet therapy (MAT) for reducing stroke recurrence among patients with weight <65 kg (5.0% vs 11.7%; hazard ratio [HR], 0.41; 95% CI: 0.22–0.76) and 65–75 kg (6.7% vs 10.8%, HR, 0.62; 95% CI: 0.43–0.89). However, no significant difference was found in stroke recurrence between DAT and MAT in patients with weight ≥75 kg (9.4% vs 11.6%; HR, 0.80; 95% CI: 0.58–1.10). A significant interaction was observed between weight and antiplatelet therapy on stroke recurrence (p<0.05). Similar result was found for combined vascular events. More bleeding events were found in DAT group among patients with <65 kg (3.7% vs 2.2%), but with no significant difference.

Conclusion

DAT does not show benefit in patients with higher weight, compared with MAT. Bleeding events found in the DAT group were not more than the MAT group among patients with lower weight.

Clinical trial registration

URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00979589.

Keywords:

• bodyweight
• dual antiplatelet therapy
• ischemic stroke
• outcomes
• TIA

Supplementary material

Co-investigators of CHANCE trial

Yongjun Wang, MD (Tiantan Hospital, Capital Medical University, principal investigator); Claiborne Johnston, MD, PhD (UCSF, principal investigator); Lawrence Wong, MD, PhD (Chinese University of Hong Kong, Prince of Wales Hospital, steering committee); David Wang, DO, FAHA, FAAN (University of Illinois College of Medicine, steering committee); James Wang, MD, PhD (University of Tennessee Health Science Center, steering committee); Mai N Nguyen-Huynh, MD, MAS (UCSF, steering committee); Chen Wang, MD (Tiantan Hospital, Capital Medical University, steering committee); Liying Cui, MD, PhD (Peking Union Medical College Hospital, steering committee); Yansheng Li, MD, PhD (Renji Hospital of Shanghai, steering committee); Qiang Dong, MD, PhD (Huashan Hospital of Fudan University, steering committee); Jianfeng Xu, MD, PhD (School of life sciences, Fudan University, steering committee); Jianping Jia, MD, PhD (Xuan Wu Hospital, Capital Medical University, steering committee); Jiang Wu, MD, PhD (First Hospital of Jilin University, steering committee); Jinsheng Zeng, MD, PhD (First Affiliated Hospital of Sun Yat-Sen University, steering committee); Xingquan Zhao, MD, PhD (Tiantan Hospital, Capital Medical University, steering committee); Liping Liu, MD, PhD (Tiantan Hospital, Capital Medical University, steering committee); Chunxue Wang, MD, PhD (Tiantan Hospital, Capital Medical University, steering committee); Yilong Wang, MD, PhD (Tiantan Hospital, Capital Medical University, steering committee); Zhimin Wang, MD (Taizhou First People’s Hospital, site investigator); Yongjun Wang, MD (BeijingTiantan Hospital, site investigator); Haiqin Xia, MD (Taiyuan Iron And Steel Co., Ltd., General Hospital, site investigator); Bin Li, MD (Dagang Oilfield Gengeal Hospital, site investigator); Guiru Zhang, MD (Penglai People’s Hospital, site investigator); Xudong Ren, MD (The Third People’s Hospital of Datong, site investigator); Chunling Ji, MD (The Fourth Central Hospital of Tianjin, site investigator); Guohua Zhang, MD (The Second Hospital of Hebei Medical University, site investigator); Jianhua Li, MD (The First Hospital of Fangshan District, Beijing, site investigator); Bohua Lu, MD (Beijing Puren Hospital, site investigator); Liping Wang, MD (Tianjin Ninghe District Hospital, site investigator); Shutao Feng, MD (The People’s Hospital of Zhengzhou, site investigator); Dali Wang, MD (Affiliated Hospital of North China Coal Medical College, site investigator); WeiguoTang, MD (Zhejiang Zhoushan Hospital, site investigator); Juntao Li, MD (Han Dan Central Hospital, site investigator); Zhecheng People’s Hospital Hongtian Zhang; Shanxi Medical University Second Hospital Guanglai Li; Baojun Wang, MD (Baotou Central Hospital, site investigator); Yuhua Chen, MD (The General Hospital of Changjiang River Shipping, site investigator); Ying Lian, MD (Dalian Economic And Technological Development Zone Hospital, site investigator); Bin Liu, MD (First Neurology Department, Affiliated Hospital of North China Coal Medical College, site investigator); Junfang Teng, MD (The First Affiliated Hospital of Zhengzhou University, site investigator); Rubo Sui, MD (First Affiliated Hospital of Liaoning Medical, site investigator); Lejun Li, MD (Lianyungang Municipal Hospital of Tcm, site investigator); Zhiling Yuan, MD (Central Hospital In Qiu County, site investigator); Dawei Zang, MD (Tianjin First Center Hospital, site investigator); Zuneng Lu, MD (Renmin Hospital of Wuhan University, site investigator); Li Sun, MD (Qingdao Central Hospital, site investigator); Dong Wang, MD (Baogang Hospital, site investigator); Liying Hou, MD (Changzhi City People’s Hospital of Shanxi Province, site investigator); Dongcai Yuan, MD (HaLixun International Peace Hospital, site investigator); Yongliang Cao, MD (People’s Hospital of Linzi District, Zibo, site investigator); Hui Li, MD (Yantai City Yantai Mountain Hospital, site investigator); Xiuge Tan, MD (Beijing Pinggu District Hospital, site investigator); Huicong Wang, MD (Taiyuan Central Hospital, site investigator); Haisong Du, MD (Chengde Central Hospital, site investigator); Mingyi Liu, MD (Shijiazhuang Central Hospital, site investigator); Suping Wang, MD (First Neurology Department, Dalian Municipal Central Hospital, site investigator); Qiuwu Liu, MD (Xian 141 Hospital, site investigator); Zhong Zhang, MD (Chengdu Third Municipal People’s Hospital, site investigator); Qifu Cui, MD (Affiliated Hospital of Chifeng University, site investigator); Runqing Wang, MD (Zhengzhou Central Hospital, site investigator); Jialin Zhao, MD (Ningbo City, Zhejiang Province Lihuili Hospital Medical Center, site investigator); Jiewen Zhang, MD (Henan Provincial People’s Hospital, site investigator); Jianping Zhao, MD (Jinzhong City Second Hospital, site investigator); Qi Bi, MD (Beijing Anzhen Hospital, Capital Medical University, site investigator); Xiyou Qi, MD (Beijing Huairou District Chinese Medicine Hospital, site investigator); Junyan Liu, MD (Hebei Medical University Third Hospital, site investigator); Changxin Li, MD (First Affiliated Hospital Shanxi Medical University, site investigator); Ling/Lv Li, MD (Hebei Provincial People’s Hospital, site investigator); Xiaoping Pan, MD (Guangzhou First Municipal People’s Hospital, site investigator); Junling Zhang, MD (Central Hospital In Cangzhou, site investigator); Derang Jiao, MD (The Chinese People’s Armed Police Force Medical School Affiliated Hospital, site investigator); Zhao Han, MD (Zhejiang Wenzhou Medical College First Affiliated Hospital, site investigator); Dawei Qian, MD (Jilin Central Hospital, site investigator); Jin Xiao, MD (Anhui Maanshan Central Hospital, site investigator); Yan Xing, MD (Beijing Aviation Industry Central Hospital, site investigator); Huishan Du, MD (Luhe Hospital, Tongzhou District, Beijing, site investigator); Guang Huang, MD (Beijing Fuxing Hospital, Capital Medical University, site investigator); Yongqiang Cui, MD (The 306th Hospital of P.L.A, site investigator); Yan Li, MD (The First Affiliated Hospital of Tianjin University of Chinese Medicine, site investigator); Lianyuan Feng, MD (Baiqiuen International Peace Hospital of People’s Liberation Army, site investigator); Lianbo Gao, MD (Fourth Affiliated Hospital of China Medical University, site investigator); Bo Xiao, MD (Xiangya Hospital Central-South University, site investigator); Yibin Cao, MD (Tangshan Worker’s Hospital, site investigator); Yiping Wu, MD (The 1st Hospital In Handan, site investigator); Jinfeng Liu, MD (Yangquan Coal (Group) Co., Ltd. General Hospital, site investigator); Zhiming Zhang, MD (Tianjin Tianhe Hospital, site investigator); Zhengxie Dong, MD (Nantong First People’s Hospital, site investigator); Limin Wang, MD (The 1st Hospital of Zhangjiakou City, site investigator); Li He, MD (West China Hospital, Sichuan University, site investigator); Xinchen Wang, MD (The Second Affiliated Hospital of Shandong University of TCM, site investigator); Xueying Guo, MD (Fenyang Hospital of Shanxi Province, site investigator); Ming Wang, MD (Zhejiang Zhoushan Putuo District People’s Hospital, site investigator); Xiaosha Wang, MD (Xiyuan Hospital of China Academy of Chinese Traditional Medicine, site investigator); Jiandong Jiang, MD (No 2 People’s Hospital East In Lianyungang City, site investigator); Renliang Zhao, MD (Affiliated Hospital of Qingdao University Medical College, site investigator); Shengnian Zhou, MD (Qilu Hospital of Shandong University, site investigator); HaoHu, MD (Zibo Hospital of Traditional Chinese Medicine, site investigator); Maolin He, MD (Beijing Shijitan Hospital, site investigator); Fengchun Yu, MD (Beijing Haidian Hospital, site investigator); Quping Ouyang, MD (Beijing Shunyi District Hospital, site investigator); Jingbo Zhang, MD (Dalian Third Municipal Hospital, site investigator); Anding Xu, MD (The First Affiliated Hospital of Jinan University, site investigator); Xiaokun Qi, MD (Navy Genaral Hospital of P.L.A, site investigator); Lei Wang, MD (Beijing Second Artillery General Hospital, site investigator); Fuming Shi, MD (Beijing Daxing District Hospital, site investigator); Fuqiang Guo, MD (Sichuan Province People’s Hospital, site investigator); Jianfeng Wang, MD (Dalian Municipal Central Hospital, site investigator); Fengli Zhao, MD (The Second Hospital In Baoding, site investigator); Ronghua Dou, MD (The Hospital Combine Traditional Chinese And Western Medicine In Cang zhou, site investigator); Dongning Wei, MD (The 309th Hospital of PLA, site investigator); Qingwei Meng, MD (Liangxiang Hospital of Fangshan District, Beijing, site investigator); Yilu Xia, MD (HuaXin Hospital First Hospital of Tsinghua University, site investigator); Shimin Wang, MD (TianjinHuanhu Hospital, site investigator); Zhangcang Xue, MD (Shijiazhuang First Hospital, site investigator); Yuming Xu, MD (The First Affiliated Hospital of Zhengzhou University, site investigator); Liping Ma, MD (Xinzhou City People’s Hospital, site investigator); Chun Wang, MD (Sichuan Province People’s Hospital of Deyang City, site investigator); Jiang Wu, MD (First Hospital, Jilin University, site investigator); Yifeng Du, MD (Shandong Provincial Hospital, site investigator); Yinzhou Wang, MD (Fujian Province Hospital, site investigator); Lijun Xiao, MD (Liaoyang City Third People’s Hospital, site investigator); Fucong Song, MD (Handan City Center Hospital, site investigator); Wenli Hu, MD (Beijing Chaoyang Hospital, Capital Medical University, site investigator); Zhigang Chen, MD (Beijing University of Chinese Medicine East Hospital, site investigator); Qingrui Liu, MD (Hebei Medical University Fourth Hospital, site investigator); Jiemin Zhang, MD (The Fourth Affiliated Hospital of Soochow University, site investigator); Mei Chen, MD (Zhejiang University of Chinese Medicine Hospital Affiliated First, site investigator); Xiaodong Yuan, MD (Affiliated Hospital of Kailuan Company Ltd, site investigator); Zhihui Liu, MD (Affiliated Hospital of Weifang Medical University, site investigator); Guozhong Li, MD (The First Hospital of Harbin Medical University, site investigator); Xiaohong Li, MD (Dalian Friendship Hospital, site investigator); Tingchen Tian, MD (Tianjin Dagang Hospital, site investigator); Xia Meng, MD, PhD (Tiantan Hospital, Capital Medical University, member of coordinating center); Jinxi Lin, MD, PhD (Tiantan Hospital, Capital Medical University, member of coordinating center); Anxin Wang, MD (Tiantan Hospital, Capital Medical University, member of coordinating center); Yong Zhou, PhD (Tiantan Hospital, Capital Medical University, member of coordinating center); Xianwei Wang, MD (Tiantan Hospital, Capital Medical University, member of coordinating center); Chao Li, MD (Tiantan Hospital, Capital Medical University, member of coordinating center); Yuan Shen, MD (Tiantan Hospital, Capital Medical University, member of coordinating center); Xianhong Liang, MD (Tiantan Hospital, Capital Medical University, member of coordinating center); Jing Jing, MD, PhD (Tiantan Hospital, Capital Medical University, member of coordinating center).

Acknowledgments

The study was supported by grants from the Ministry of Science and Technology of the People’s Republic of China (2016YFC1307300, 2013BAI09B03 and 2011BAI08B02), and a grant from Beijing Municipal Administration of Hospitals’ Youth Programme (QML2015 0504).

Disclosure

The authors report no conflicts of interest in this work.