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CHANCE: Clopidogrel plus aspirin lowered risk for second stroke

Issue: March 2013

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Adding clopidogrel to aspirin therapy in the weeks following a minor stroke or transient ischemic attack reduced the risk for a second stroke by more than 30%, according to results from the CHANCE trial presented at the International Stroke Conference 2013. 

Researchers studied 5,170 Chinese patients (mean age, 62 years; 34% women) who had a minor ischemic stroke or TIA. Patients were randomly assigned within 24 hours of symptom onset to a clopidogrel 300-mg loading dose followed by 75 mg daily plus aspirin 75 mg for the first 21 days or to aspirin alone. On day 1, all patients received open-label aspirin 75 mg to 300 mg. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up.

Stroke occurred in 11.7% of the aspirin alone group compared with 8.2% of the clopidogrel plus aspirin group (HR=0.68; 95% CI, 0.57-0.81). Both groups experienced similar occurrence of moderate or severe stroke (0.3%) and hemorrhagic stroke (0.3%).

“[These data] suggest that combination therapy is more effective than aspirin alone, and is a safe treatment,” S. Claiborne Johnston, MD, PhD, professor of neurology and director of the stroke service at University of California, San Francisco, said at a press conference.

According to Yongjun Wang, MD, professor of neurology and vice president of Beijing TianTan Hospital, Capital Medical University, China, “In China, stroke and mini-stroke patients are 6 to 8 years younger, on average, than Americans, and there are different genetic variations that have an impact on the metabolism of clopidogrel.”

Johnston said he suspects that these data will also apply to patients and clinical settings in the United States, and data from the ongoing POINT trial will provide more information on dual therapy in this patient population.

For more information:

Wang Y. LB11. Presented at: International Stroke Conference 2013; Feb. 5-8, 2013; Honolulu.

Disclosure: The study was funded by the Chinese Ministry of Science and Technology.