Infarction patterns determine benefit of dual antiplatelet therapy for stroke patients

Patients with multiple acute infarction patterns may benefit the most from dual antiplatelet therapy compared to others who have experienced a minor stroke, according to a recent study of imaging data published online March 26 in the Journal of the American Medical Association.   

Researchers led by Jing Jing, MD, PhD from the department of neurology at Beijing Tiantan Hospital at Capital Medical University in Beijing, examined how patients with different infarction patterns after a minor stroke would benefit differently from clopidogrel with aspirin versus aspirin alone for treatment.  

This imaging substudy, the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE), included 1,342 patients with minor stroke at 45 sites of CHANCE from October 1, 2009, to July 30, 2012. When final analysis was conducted July 30, 2016, a total of 1,089 participants remained in the study and all had undergone MRI exams, according to study methods. The average age of study participants was 63 years and 65 percent were men.  

Additionally, researchers compiled all 1,089 participants based on diffusion-weighted imaging data into the following groups: 25.8 percent had multiple acute infarctions (MAIs), 50.8 percent had single acute infarction (SAI), and 23.4 percent no acute infarction (NAI). Researchers found a 50 percent risk reduction in stroke recurrence in patients with MAIs administered clopidogrel plus aspirin compared with aspirin alone. However, the same was not observed in patients with SAI or NAI.   

"Patients with MAIs received the most pronounced clinical benefit from dual antiplatelet therapy without increasing the risk of moderate to severe bleeding," according to the researchers. "However, even if after dual antiplatelet treatment, patients with MAIs still had a risk of stroke recurrence as high as those with SAI. Therefore, from a clinical practice point of view, our results suggest that patients with MAIs should receive early and dual antiplatelet treatment."