Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data
Journal
Journal of the American Heart Association
Journal Volume
7
Journal Issue
19
Pages
e009856
Date Issued
2018
Author(s)
Chi N.-F.
Wen C.-P.
Liu C.-H.
Li J.-Y.
Chen C.-H.
Lien L.-M.
Lin C.-H.
Sun Y.
Chang W.-L.
Hu C.-J.
Hsu C.Y.
Taiwan Stroke Registry Investigators
Abstract
Background-Clopidogrel was thought to be superior to aspirin for secondary prevention of vascular diseases in clinical trials. In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real-world practice by using the Taiwan Stroke Registry. Methods and Results-Patients with ischemic stroke (2006-2016) on aspirin or clopidogrel for secondary stroke prevention were identified in the Taiwan Stroke Registry. Stroke recurrence and mortality rates in patients receiving aspirin (N=34 679) were compared with those receiving clopidogrel (N=7611) during a 12-month follow-up period. Propensity score matching and conditional Cox proportional hazards regression model were applied to control confounding factors with 6443 patients in each group. After propensity score matching stroke recurrence rates were comparable between groups with 223 patients in the aspirin (3.46%) and 244 in the clopidogrel group (3.79%) (hazard ratio=1.13 95% confidence interval=0.89-1.43 P=0.311). However the mortality rate was significantly higher in the clopidogrel group (362 patients 5.62%) than in the aspirin group (302 patients 4.69%) (hazard ratio=1.30 95% confidence interval=1.07-1.58 P=0.008). Results were consistent before and after propensity score matching. Conclusions-Clopidogrel was as effective as aspirin for prevention of recurrent stroke in real-world practice. However the mortality rate was significantly higher in the clopidogrel than in the aspirin group. ? 2018 The Authors.
Subjects
Aspirin; Clopidogrel; Prevention; Stroke
SDGs
Other Subjects
acetylsalicylic acid; clopidogrel; acetylsalicylic acid; antithrombocytic agent; clopidogrel; aged; all cause mortality; Article; brain ischemia; cerebrovascular accident; comparative effectiveness; controlled study; drug efficacy; drug safety; female; follow up; human; major clinical study; male; mortality rate; National Institutes of Health Stroke Scale; priority journal; Rankin scale; recurrence risk; recurrent disease; retrospective study; secondary stroke; secondary stroke; treatment outcome; cerebrovascular accident; clinical trial; comparative study; incidence; multicenter study; procedures; propensity score; register; secondary prevention; survival rate; Taiwan; Aged; Aspirin; Clopidogrel; Female; Follow-Up Studies; Humans; Incidence; Male; Platelet Aggregation Inhibitors; Propensity Score; Recurrence; Registries; Retrospective Studies; Secondary Prevention; Stroke; Survival Rate; Taiwan; Treatment Outcome
Type
journal article