Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data

Taiwan Stroke Registry Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere009856
JournalJournal of the American Heart Association
Volume7
Issue number19
DOIs
Publication statusPublished - 2018 Oct 1

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clopidogrel
Secondary Prevention
Aspirin
Stroke
Propensity Score
Taiwan
Registries
Mortality
Confidence Intervals
Recurrence
Vascular Diseases
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{faa21ff4a54b4fc5bf1f781c99ed0008,
title = "Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data",
abstract = "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.",
author = "{Taiwan Stroke Registry Investigators} and Chi, {Nai Fang} and Wen, {Chi Pang} and Liu, {Chung Hsiang} and Li, {Jie Yuan} and Jeng, {Jiann Shing} and Chen, {Chih Hung} and Lien, {Li Ming} and Lin, {Ching Huang} and Yu Sun and Chang, {Wei Lun} and Hu, {Chaur Jong} and Hsu, {Chung Y.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1161/JAHA.118.009856",
language = "English",
volume = "7",
journal = "Journal of the American Heart Association",
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Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data. / Taiwan Stroke Registry Investigators.

In: Journal of the American Heart Association, Vol. 7, No. 19, e009856, 01.10.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data

AU - Taiwan Stroke Registry Investigators

AU - Chi, Nai Fang

AU - Wen, Chi Pang

AU - Liu, Chung Hsiang

AU - Li, Jie Yuan

AU - Jeng, Jiann Shing

AU - Chen, Chih Hung

AU - Lien, Li Ming

AU - Lin, Ching Huang

AU - Sun, Yu

AU - Chang, Wei Lun

AU - Hu, Chaur Jong

AU - Hsu, Chung Y.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

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U2 - 10.1161/JAHA.118.009856

DO - 10.1161/JAHA.118.009856

M3 - Article

C2 - 30371321

AN - SCOPUS:85055612493

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 19

M1 - e009856

ER -