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Bleeding risk of dual antiplatelet therapy after minor stroke or transient ischemic attack

Annals of Neurology Wang A, Meng X, Tian X, et al. | January 12, 2022

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In patients with CYP2C19 loss-of-function alleles who received dual antiplatelet therapy after minor stroke or transient ischemic attack, findings revealed occurrence of bleeding events mostly within the 21-day dual antiplatelet therapy stage and these events were generally mild. Bleeding risk was found to be greater in nonsmoking patients, and was linked with treatment with ticagrelor-aspirin vs clopidogrel-aspirin, especially in cases aged <65 years and nondiabetic patients.

  • From the CHANCE-2 (Clopidogrel with Aspirin in High-Risk Patients with Acute Non-disabling Cerebrovascular Events II) trial, a total of 6,412 participants were analyzed to determine the risk of bleeding events and potential risk factors within 90 days in patients who received dual antiplatelet therapy after minor stroke or transient ischemic attack.

  • Overall 250 (3.9%) bleeding events occurred, mainly within the 21 days of dual antiplatelet treatment (200 cases, 3.1%).

  • Most frequent were minor bleeding of the skin bruises, epistaxis, and gum bleeding.

  • Elevated bleeding (hazard ratio [HR] = 2.21) was shown in relation to treatment with ticagrelor-aspirin vs clopidogrel-aspirin, in multivariate analysis.

  • A lower risk of bleeding (HR = 0.70) was observed in relation to current smoking.

  • In patients aged <65 years and those without diabetes mellitus, higher risk of bleeding was observed in relation to ticagrelor-aspirin vs clopidogrel-aspirin, with HRs 2.87 and 2.65, respectively, in these groups.

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