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August 18, 2015; 85 (7) Article

Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke

CHANCE substudy

Xianwei Wang, Xingquan Zhao, S. Claiborne Johnston, Ying Xian, Bo Hu, Chunxue Wang, David Wang, Liping Liu, Hao Li, Jiming Fang, Xia Meng, Anxin Wang, Yongjun Wang, Yilong Wang, For the CHANCE investigators
First published July 17, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001844
Xianwei Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Xingquan Zhao
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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S. Claiborne Johnston
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Ying Xian
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Bo Hu
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Chunxue Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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David Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Liping Liu
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Hao Li
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Jiming Fang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Xia Meng
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Anxin Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Yongjun Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Yilong Wang
From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
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Citation
Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke
CHANCE substudy
Xianwei Wang, Xingquan Zhao, S. Claiborne Johnston, Ying Xian, Bo Hu, Chunxue Wang, David Wang, Liping Liu, Hao Li, Jiming Fang, Xia Meng, Anxin Wang, Yongjun Wang, Yilong Wang, For the CHANCE investigators
Neurology Aug 2015, 85 (7) 573-579; DOI: 10.1212/WNL.0000000000001844

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Abstract

Objective: We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA.

Methods: Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2–6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less.

Results: Poor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups.

Conclusions: In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm.

Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%–3.42%).

GLOSSARY

CHANCE=
Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events;
CI=
confidence interval;
EQ-5D=
EuroQol-5 Dimension;
mRS=
modified Rankin Scale;
NIHSS=
NIH Stroke Scale;
OR=
odds ratio

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Coinvestigators are listed on the Neurology® Web site at Neurology.org.

  • Editorial, page 562

  • Supplemental data at Neurology.org

  • Received November 23, 2014.
  • Accepted in final form April 16, 2015.
  • © 2015 American Academy of Neurology
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