Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a subgroup analysis of the CHANCE- 2 trial  

作　　者：Xinmiao Zhang Jing Jing Anxin Wang Xuewei Xie S Claiborne Johnston Hao Li Philip M Bath Qin Xu Jinxi Lin Yilong Wang Xingquan Zhao Zixiao Li Yong Jiang Liping Liu Weifeng Chen Xuhai Gong Jianhua Li Xinsheng Han Xia Meng Yongjun Wang 

机构地区：[1]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [2]China National Clinical Research Center for Neurological Diseases,Beijing,China [3]Dell Medical School,University of Texas at Austin,Austin,Texas,USA [4]Stroke Trials Unit,Mental Health&Clinical Neuroscience,University of Nottingham,Nottingham,UK [5]Department of Neurology,Xingyang People's Hospital,Henan,China [6]Daqing Oilfield General Hospital,Daqing,Heilongjiang,China [7]The First Hospital of Fangshan District,Beijing,China [8]Kaifeng Central Hospital,Henan,China

出　　处：《Stroke & Vascular Neurology》2024年第5期541-550,共10页卒中与血管神经病学（英文）

基　　金：Ministry of Science and Technology of the People’s Republic of China(MOST),Beijing Municipal Science&Technology Commission and Chinese Stroke Association(CSA),Beijing Municipal Science&Technology Commission,and grants from the National Science and Technology Major Project(2017ZX09304018);Capital's Funds for Health Improvement and Research(2020-1-2041);Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-5-029);National Natural Science Foundation of China(81870905,82101357,U20A20358).

摘　　要：Objectives Evidence of the optimal antiplatelet therapy for elderly patients who had a stroke is limited,especially those elder than 80 years.This study aimed to explore the efficacy and safety of dual antiplatelet therapy(DAPT)in old-old patients compared with younger patients in the ticagrelor or Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events-II(CHANCE-2)trial.Methods CHANCE-2 was a randomised,double-blind,placebo-controlled trial in China involving patients with high-risk transient ischaemic attack or minor stroke with CYP2C19 loss-of-function alleles.In our substudy,all enrolled patients were stratified by age:old-old(≥80 years),young-old(65–80 years)and younger(<65 years).The primary outcomes were stroke recurrence and moderate to severe bleeding within 90 days,respectively.Results Of all the 6412 patients,406(6.3%)were old-old,2755(43.0%)were young-old and 3251(50.7%)were younger.Old-old patients were associated with higher composite vascular events(HR 1.41,95%CI 1.00 to 1.98,p=0.048),disabling stroke(OR 2.43,95%CI 1.52 to 3.88,p=0.0002),severe or moderate bleeding(HR 8.40,95%CI 1.95 to 36.21,p=0.004)and mortality(HR 7.56,95%CI 2.23 to 25.70,p=0.001)within 90 days.Ticagrelor-aspirin group was associated with lower risks of stroke recurrence within 90 days in younger patients(HR 0.68,95%CI 0.51 to 0.91,p=0.008),which was no differences in old-old patients.Conclusion Elderly patients aged over 80 in CHANCE-2 trial had higher risks of composite vascular events,disabling stroke,severe or moderate bleeding and mortality within 90 days.Genotype-guided DAPT might not be as effective in old-old patients as in younger ones.Trial registration number NCT04078737.

关 键 词：PREVENTION YOUNGER STRATIFIED 

分 类 号：R743.3[医药卫生—神经病学与精神病学]