医学
阿司匹林
替卡格雷
氯吡格雷
冲程(发动机)
危险系数
内科学
风险因素
心脏病学
置信区间
机械工程
工程类
作者
Anxin Wang,Xia Meng,Xue Tian,S. Claiborne Johnston,Hao Li,Philip M.W. Bath,Yingting Zuo,Xuewei Xie,Jing Jing,Jun Lin,Yongjun Wang,Xingquan Zhao,Zixiao Li,Yong Jiang,Liping Liu,Feng Wang,Yanxia Wang,Pan-bing Huang,Guofang Chen,Yongjun Wang
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2022-06-03
卷期号:53 (9): 2799-2808
被引量:1
标识
DOI:10.1161/strokeaha.122.038662
摘要
Hypertension is a risk factor of poor stroke outcomes and associated with antiplatelet resistance. This study aimed to explore the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in patients with different hypertension status, using randomized trial data from the CHANCE-2 trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events-II).A total of 6412 patients with minor stroke or transient ischemic attack who carried CYP2C19 loss-of-function alleles were enrolled and randomized to either ticagrelor-aspirin or clopidogrel-aspirin group. Hypertension status were classified into no, newly diagnosed, and previously diagnosed hypertension according to medical history, blood pressure, and antihypertensive medications during hospitalization. The primary efficacy and safety outcomes were stroke recurrence and moderate to severe bleeding risk within 90-day follow-up.Ticagrelor-aspirin was associated with reduced risk of new stroke in patients without hypertension (32 [4.8%] versus 60 [7.2%]; hazard ratio, 0.55 [95% CI, 0.35-0.86]), but not in those with a newly diagnosed hypertension (20 [5.3%] versus 36 [9.1%]; hazard ratio 0.59 [95% CI, 0.33-1.07]), or those with a previously diagnosed hypertension (139 [7.0%] versus 147 [7.4%]; hazard ratio, 0.93 [95% CI, 0.74-1.18]) compared with clopidogrel-aspirin (P=0.04 for interaction). The risk of bleeding for ticagrelor-aspirin was not associated with hypertension status (0.1% versus 0.4%; 0.3% versus 0.5%, 0.4% versus 0.3%, P=0.50 for interaction). All the efficacy and safety outcomes between treatments did not differ by blood pressure levels on admission.In the CHANCE-2 trial, patients without hypertension received a significantly greater benefit from ticagrelor- aspirin than those with previous hypertension after minor stroke or transient ischemic attack, and a similar benefit trend was observed in those with newly diagnosed hypertension.URL: https://www.gov; Unique identifier: NCT04078737.
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