Clinical Outcomes Of Aspirin Combined With Clopidogrel In Treatment Of Minor Noncardioembolic Ischemic Stroke(NIHSS ≤5)

Objective:The objective of this paper is to analysis the effect of dual antiplatelet therapy(DAPT)with aspirin combined with clopidogrel and aspirin monotherapy on the clinical outcomes of hospitalized patients with mild non-cardiogenic stroke in the real world from 2010 to 2018,compare the safety and efficacy of the two groups,and describe the trend in the use of dual antiplatelet drugs.Methods:A retrospective observational cohort study was conducted on patients with acute minor non-cardiac stroke admitted to 72 h from three tertiary first-class hospitals from March 2010 to December 2018 in Shanxi Province,China.According to the principle of intention-to-treat,the patients were divided into different groups of antiplatelet drugs,including aspirin group(aspirin 100mg-300mg/day)and load dual antiplatelet therapy(load DAPT)group(aspirin 100mg-300mg/day combined with clopidogrel first loading dose 300mg/day,the latter 75mg/day).The clinical outcome of hospitalized patients was observed.The main outcome was recurrent stroke,defined as the composite of new onset ischemic stroke,hemorrhagic stroke and transient ischemic attack(TIA).The safety outcome was any bleeding event.Cox proportional hazard regression model was used to adjust confounding factors,and the main outcomes and safety outcomes of different antiplatelet therapy were compared.The Kaplan-Meier method was used to draw the survival curve of stroke recurrence.Results:From 2010 to 2018,a total of 1018 patients with acute minor non-cardiac stroke(NIHSS ≤ 5)within 72 hours of onset were enrolled in the study,including 544cases(53.4%)in aspirin group,474 cases(46.6%)in load DAPT group.Stroke recurrence occurred in 33 patients(6.96%)in the load DAPT group and 42 patients(7.72%)in the aspirin group.After adjusting for age,sex,previous history of hypertension,smoking,low density lipoprotein cholesterol,creatinine,diabetes,TOAST classification and infarct area confounding factors,the risk of stroke recurrence in the load DAPT group was significantly reduced(HR 0.58,95%CI 0.34-0.99,P=0.046),and the difference was statistically significant.In terms of secondary outcomes,the load DAPT group did not significantly reduce the risk of ischemic stroke,hemorrhagic stroke and TIA.In terms of safety outcomes,there was no significant increase in bleeding risk in the load DAPT group.The Kaplan-Meier curve showed that the risk of major outcomes mainly occurred in the first 5 days of hospitalization.From 2010 to 2018,the proportion of patients receiving load DAPT increased year by year,while the proportion of aspirin monotherapy showed a downward trend.Conclusion:In the real world,compared with aspirin alone,aspirin combined with clopidogrel load dual antiplatelet therapy could reduce the risk of in-hospital stroke recurrence in patients with minor non-cardiac stroke with onset time ≤ 72 hours or NIHSS ≤ 5,and did not increase the risk of bleeding.The proportion of load DAPT increased year by year from 2010 to 2018.