Comparative effectiveness and safety of antiplatelet drug regimens as secondary prevention after ischemic stroke or transient ischemic attack
Publication date
2017-08-01
Authors
Yasmina, Alfi
De Boer, Anthonius
Deneer, Vera H M
Ten Berg, Jurrien M
Groenwold, Rolf H.H.
Souverein, Patrick
Klungel, Olaf H.
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Abstract
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Abstract
Background: Different antiplatelet regimens are recommended for secondary prevention after ischemic stroke/transient ischemic attack (TIA), but studies on the comparative effectiveness and safety of each regimen in daily practice are lacking, particularly for the aspirin-clopidogrel regimen. Objectives: To assess the comparative effectiveness and safety of antiplatelet regimens as secondary prevention after ischemic stroke or TIA. Methods: A cohort study was conducted using data from the Clinical Practice Research Datalink. Patients aged ≥18 years with a first diagnosis of ischemic stroke or TIA in 1999-2013 who started an antiplatelet drug within 90 days after diagnosis were identified. Antiplatelet exposure was assessed during follow-up and categorized into aspirin-dipyridamole, aspirinonly, clopidogrel-only, aspirin-clopidogrel, others, and no use (discontinuers). The primary effectiveness outcome was ischemic stroke, and the safety outcome was major bleeding. Time-dependent Cox regression analysis was used to assess the associations between antiplatelet regimens and study outcomes, adjusted for confounders. Results: A total of 20,542 ischemic stroke/TIA patients were followed for a median duration of 2.4 years. There were 2916 (14.2%) ischemic stroke events during follow-up. Aspirin-only (HR 1.19, 95%CI 1.05-1.34) and clopidogrel-only (HR 1.21, 1.05-1.40) regimens were less effective compared to aspirin-dipyridamole in reducing the risk of ischemic stroke, while the aspirin-clopidogrel regimen was not statistically different (HR 1.13, 0.93-1.37). Clopidogrel-only (HR 1.41, 1.17-1.70) and aspirinclopidogrel (HR 1.66, 1.29-2.13) regimens were associated with a higher risk of major bleeding compared to aspirin-dipyridamole in patients without previous major bleeding. Conclusions: Compared to other antiplatelet regimens, an aspirin-dipyridamole regimen appears to have a favourable benefit-risk profile for secondary prevention after ischemic stroke/TIA.
Keywords
acetylsalicylic acid, acetylsalicylic acid plus clopidogrel, acetylsalicylic acid plus dipyridamole, clopidogrel, adult, bleeding, clinical practice, clinical trial, cohort analysis, comparative effectiveness, controlled clinical trial, controlled study, diagnosis, female, follow up, human, human cell, major clinical study, male, pharmacokinetics, proportional hazards model, secondary prevention, thrombocyte, transient ischemic attack, young adult, SDG 3 - Good Health and Well-being
Citation
Yasmina, A, De Boer, A, Deneer, V H M, Ten Berg, J M, Groenwold, R H H, Souverein, P C & Klungel, O H 2017, 'Comparative effectiveness and safety of antiplatelet drug regimens as secondary prevention after ischemic stroke or transient ischemic attack', 33rd International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 26/08/17 - 30/08/17 pp. 490-491. https://doi.org/10.1002/pds.4275, conference