Dual antiplatelet therapy for TIA reduces subsequent disability A CHANCE to improve outcomes?

摘要

In this issue of Neurology (R), Wang et al.(1) report the results of a subanalysis of the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of dual antiplatelet agents administered within 24 hours of onset of high-risk TIA (defined as ABCD(2) score 4) or minor stroke (defined as NIH Stroke Scale score 3). In this study, they explored the outcomes of functional disability, as measured by the modified Rankin Scale, and quality of life, as measured by the EuroQol-5 Dimension. The published CHANCE trial results demonstrated that the combination of clopidogrel and aspirin (for 21 days, followed by clopidogrel alone until 90 days) was superior to aspirin plus placebo for 90 days in preventing recurrent stroke after TIA or minor stroke.(2) The current study demonstrates the superiority of dual antiplatelet therapy compared to aspirin in improving the 90-day functional outcome. The analysis suggests that this is mediated via a reduction in the occurrence of disabling stroke. The finding has importance to patients, clinicians, and policymakers, because disability from stroke has personal, economic, and societal implications.