Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial
Background and purpose Symptomatic internal carotid artery stenosis (sCAS) is an essential cause of transient ischaemic attack (TIA) or minor stroke. We aimed to evaluate whether the superiority of aspirin-ticagrelor over aspirin-clopidogrel varies between patients with sCAS or not.Methods This was...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
|
| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2025/01/07/svn-2024-003293.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841551028869136384 |
|---|---|
| author | Yongjun Wang Yilong Wang Xingquan Zhao Jing Jing Hao Li Xia Meng Anxin Wang Yong Jiang Jinxi Lin Qin Xu Xuewei Xie Pan Chen |
| author_facet | Yongjun Wang Yilong Wang Xingquan Zhao Jing Jing Hao Li Xia Meng Anxin Wang Yong Jiang Jinxi Lin Qin Xu Xuewei Xie Pan Chen |
| author_sort | Yongjun Wang |
| collection | DOAJ |
| description | Background and purpose Symptomatic internal carotid artery stenosis (sCAS) is an essential cause of transient ischaemic attack (TIA) or minor stroke. We aimed to evaluate whether the superiority of aspirin-ticagrelor over aspirin-clopidogrel varies between patients with sCAS or not.Methods This was a post-hoc analysis of the High-Risk Patients with Acute Nondisabling Cerebrovascular Events-II (CHANCE-2) trial, all of which were CYP2C19 loss-of-function alleles carriers. The primary exposures of interest were the treatment group and sCAS status. The primary efficacy endpoint was the new stroke assessed within 90 days.Results A total of 5920 (92.3%) from 6412 were analysed, including 197 (3.3%) with sCAS and 5723 (96.7%) without sCAS. Stroke recurrence occurred in 13 (12.15%) and 11 (12.22%) patients with sCAS who received aspirin-ticagrelor and aspirin-clopidogrel, respectively (adjusted HR, 1.04; 95% CI, 0.46 to 2.36; p=0.930). Among patients without sCAS, there were 158 cases (5.52%) of new strokes in the aspirin-ticagrelor group and 222 cases (7.76%) in the aspirin-clopidogrel group (HR, 0.70; 95% CI, 0.57 to 0.86; p=0.0006). The treatment-by-sCAS subtype was not significant (p=0.405).Conclusions Genotype-guided dual antiplatelet treatment with aspirin-ticagrelor may be beneficial for preventing recurrent strokes in patients without sCAS; however, it appears less effective in those with sCAS. No significant interaction was found between the treatment and sCAS subtypes.Trial registration number NCT04078737. |
| format | Article |
| id | doaj-art-e2e6b6ec5a814d64ac6a6625eee48cbc |
| institution | Kabale University |
| issn | 2059-8696 |
| language | English |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj-art-e2e6b6ec5a814d64ac6a6625eee48cbc2025-01-09T17:10:10ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2024-003293Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trialYongjun Wang0Yilong Wang1Xingquan Zhao2Jing Jing3Hao Li4Xia Meng5Anxin Wang6Yong Jiang7Jinxi Lin8Qin Xu9Xuewei Xie10Pan Chen11Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaDepartment of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, PR ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaBackground and purpose Symptomatic internal carotid artery stenosis (sCAS) is an essential cause of transient ischaemic attack (TIA) or minor stroke. We aimed to evaluate whether the superiority of aspirin-ticagrelor over aspirin-clopidogrel varies between patients with sCAS or not.Methods This was a post-hoc analysis of the High-Risk Patients with Acute Nondisabling Cerebrovascular Events-II (CHANCE-2) trial, all of which were CYP2C19 loss-of-function alleles carriers. The primary exposures of interest were the treatment group and sCAS status. The primary efficacy endpoint was the new stroke assessed within 90 days.Results A total of 5920 (92.3%) from 6412 were analysed, including 197 (3.3%) with sCAS and 5723 (96.7%) without sCAS. Stroke recurrence occurred in 13 (12.15%) and 11 (12.22%) patients with sCAS who received aspirin-ticagrelor and aspirin-clopidogrel, respectively (adjusted HR, 1.04; 95% CI, 0.46 to 2.36; p=0.930). Among patients without sCAS, there were 158 cases (5.52%) of new strokes in the aspirin-ticagrelor group and 222 cases (7.76%) in the aspirin-clopidogrel group (HR, 0.70; 95% CI, 0.57 to 0.86; p=0.0006). The treatment-by-sCAS subtype was not significant (p=0.405).Conclusions Genotype-guided dual antiplatelet treatment with aspirin-ticagrelor may be beneficial for preventing recurrent strokes in patients without sCAS; however, it appears less effective in those with sCAS. No significant interaction was found between the treatment and sCAS subtypes.Trial registration number NCT04078737.https://svn.bmj.com/content/early/2025/01/07/svn-2024-003293.full |
| spellingShingle | Yongjun Wang Yilong Wang Xingquan Zhao Jing Jing Hao Li Xia Meng Anxin Wang Yong Jiang Jinxi Lin Qin Xu Xuewei Xie Pan Chen Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial Stroke and Vascular Neurology |
| title | Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial |
| title_full | Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial |
| title_fullStr | Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial |
| title_full_unstemmed | Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial |
| title_short | Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial |
| title_sort | dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with tia or minor stroke with or without symptomatic carotid artery stenosis a post hoc analysis of the chance 2 trial |
| url | https://svn.bmj.com/content/early/2025/01/07/svn-2024-003293.full |
| work_keys_str_mv | AT yongjunwang dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT yilongwang dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT xingquanzhao dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT jingjing dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT haoli dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT xiameng dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT anxinwang dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT yongjiang dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT jinxilin dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT qinxu dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT xueweixie dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial AT panchen dualantiplatelettherapywithticagrelorvsclopidogrelinpatientswithtiaorminorstrokewithorwithoutsymptomaticcarotidarterystenosisaposthocanalysisofthechance2trial |