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Treatment of double stroke after acute stroke

2017-08-05

Korean studies did not receive the results of Wang Yongjun's CHANCE study

Since the CHANCE study, double therapy has become important for patients with acute non-cardiogenic ischemic stroke and transient ischemic attack (TIA). However, due to the CHANCE study on the screening of double-resistant populations and the duration of medication, the conclusion does not apply to all cases.

Recently, a study in South Korea has raised the challenge of post-stroke double-antibody therapy, suggesting that aspirin + clopidogrel does not reduce the risk of ischemic lesions on MRI 30 days after stroke compared with aspirin alone. (Stroke. July 14 online version)

The study, entitled COMPRESS, included 334 patients with macroangiopathyal atherosclerotic acute ischemic stroke at 20 Korea Medical Centers from 2009 to 2012. They were randomized to the double-antibody group (aspirin + clopidogrel) and monoclonal antibody Group (aspirin + placebo), continuous treatment for 30 days. Aspirin was administered at a dose of 300 mg, followed by 100 mg / day; clopidogrel was 75 mg / d. Patients were randomized to receive standard MRI scans at 7 and 30 days to assess intracranial ischemic lesions.

The results showed that 36.5% of the patients in the double antibody group showed new ischemic lesions on the MRI, compared with 35.9% (RR = 1.02) in the monoclonal antibody group. Most (94.2%) new ischemic foci were asymptomatic.

There were no subgroups of patients who had benefited from double therapy in the subgroup analysis, and there was no difference in post-stroke disability.

Although not statistically significant, doublebodies had a greater trend of hemorrhagic events than monoclonal antibodies, including a large increase in bleeding events or fatal bleeding (7 and 2).

It was suggested that the study differs from the CHANCE study in that the patient was included in the study after stroke (although within 48 h) and did not give a clopidogrel loading dose, which could result in a double antibody The decline in the benefits. Compared with the CHANCE study, COMPRESS studied antiplatelet therapy for longer treatment.


The study focused on the broader inclusion criteria of atherosclerotic disease, making the study more universal, but the ability to find differences between groups may be hampered. Other ongoing studies, such as the POINT study, will help determine the status of double therapy in secondary prevention of stroke.


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