Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data
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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009856 |
| _version_ | 1818315389985095680 |
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| author | Nai‐Fang Chi Chi‐Pang Wen Chung‐Hsiang Liu Jie‐Yuan Li Jiann‐Shing Jeng Chih‐Hung Chen Li‐Ming Lien Ching‐Huang Lin Yu Sun Wei‐Lun Chang Chaur‐Jong Hu Chung Y. Hsu |
| author_facet | Nai‐Fang Chi Chi‐Pang Wen Chung‐Hsiang Liu Jie‐Yuan Li Jiann‐Shing Jeng Chih‐Hung Chen Li‐Ming Lien Ching‐Huang Lin Yu Sun Wei‐Lun Chang Chaur‐Jong Hu Chung Y. Hsu |
| author_sort | Nai‐Fang Chi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T09:04:46Z |
| format | Article |
| id | doaj.art-d5ed18f8871d4043822facdce87c4e50 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T09:04:46Z |
| publishDate | 2018-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d5ed18f8871d4043822facdce87c4e502022-12-21T23:53:05ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-10-0171910.1161/JAHA.118.009856Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World DataNai‐Fang Chi0Chi‐Pang Wen1Chung‐Hsiang Liu2Jie‐Yuan Li3Jiann‐Shing Jeng4Chih‐Hung Chen5Li‐Ming Lien6Ching‐Huang Lin7Yu Sun8Wei‐Lun Chang9Chaur‐Jong Hu10Chung Y. Hsu11Department of Neurology School of Medicine College of Medicine Taipei Medical University Taipei TaiwanInstitute of Population Health Sciences National Health Research Institutes Zhunan TaiwanDepartment of Neurology China Medical University Hospital Taichung TaiwanDepartment of Neurology E‐Da Hospital Kaohsiung TaiwanDepartment of Neurology National Taiwan University Hospital Taipei TaiwanDepartment of Neurology College of Medicine National Cheng Kung University Tainan TaiwanDepartment of Neurology School of Medicine College of Medicine Taipei Medical University Taipei TaiwanDepartment of Neurology Kaohsiung Veterans General Hospital Kaohsiung TaiwanDepartment of Neurology En Chu Kong Hospital New Taipei City TaiwanDepartment of Neurology Show‐Chwan Memorial Hospital Changhua TaiwanDepartment of Neurology School of Medicine College of Medicine Taipei Medical University Taipei TaiwanDepartment of Neurology China Medical University Hospital Taichung TaiwanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.118.009856aspirinclopidogrelpreventionstroke |
| spellingShingle | Nai‐Fang Chi Chi‐Pang Wen Chung‐Hsiang Liu Jie‐Yuan Li Jiann‐Shing Jeng Chih‐Hung Chen Li‐Ming Lien Ching‐Huang Lin Yu Sun Wei‐Lun Chang Chaur‐Jong Hu Chung Y. Hsu Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aspirin clopidogrel prevention stroke |
| title | Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data |
| title_full | Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data |
| title_fullStr | Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data |
| title_full_unstemmed | Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data |
| title_short | Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real‐World Data |
| title_sort | comparison between aspirin and clopidogrel in secondary stroke prevention based on real world data |
| topic | aspirin clopidogrel prevention stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009856 |
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