机构：[a]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing重点科室诊疗科室神经病学中心神经病学中心首都医科大学附属天坛医院[b]China National Clinical Research Center for Neurological Diseases, Beijing[c]Center of Stroke, Beijing Institute for Brain Disorders, Beijing[d]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China[e]Department of Neurology, Duke University Medical Center, Durham, NC, USA[f]Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室医技科室放射科放射科首都医科大学附属天坛医院
Background and purpose The efficacy of dual antiplatelet treatment may be modified by many factors. The aim was to assess whether the effect of clopidogrel plus aspirin versus aspirin alone on recurrent stroke would be affected by admission activated partial thromboplastin time (aPTT). Methods Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A total of 5074 patients were categorized into three groups based on the aPTT distribution according to the 15th and 85th percentile. The primary outcome was any stroke within 90 days. The interaction of aPTT with antiplatelet therapy on stroke risk was assessed with a Cox proportional hazards model with adjustment for covariates. Results In the high aPTT group (defined as >= 35.9 s), stroke occurred in 6.7% of patients in the clopidogrel-aspirin arm and 11.9% in the aspirin arm [adjusted hazard ratio (HR) 0.50; 95% confidence interval (CI) 0.29-0.85]. In the medium aPTT group (24.6-35.8 s), stroke occurred in 7.7% of patients in the clopidogrel-aspirin arm and 11.8% in the aspirin arm (adjusted HR 0.62; 95% CI 0.50-0.75). Furthermore, in the low aPTT group (<= 24.5 s), stroke occurred in 11.2% of patients in the clopidogrel-aspirin arm and 9.9% in the aspirin arm (adjusted HR 1.07; 95% CI 0.65-1.62). The interaction P value of antiplatelet therapy with aPTT level at the cut-point of approximately 25 s or below was significant (P < 0.05). Conclusions Dual antiplatelet therapy was superior to single antiplatelet therapy in the high or medium aPTT group but not in the low aPTT group.
基金：
National Key R&D Program of China [2016YFC1307300, 2016YFC1307301]; Ministry of Science and Technology of the People's Republic of ChinaMinistry of Science and Technology, China [2012ZX09303, 2011BAI08B02, 200902004]
第一作者机构：[a]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing[b]China National Clinical Research Center for Neurological Diseases, Beijing[c]Center of Stroke, Beijing Institute for Brain Disorders, Beijing[d]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
共同第一作者：
通讯作者：
通讯机构：[a]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing[b]China National Clinical Research Center for Neurological Diseases, Beijing[c]Center of Stroke, Beijing Institute for Brain Disorders, Beijing[d]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China[*1]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tian Tan Xi Li, Dongcheng District, Beijing 100050, China
推荐引用方式(GB/T 7714)：
X. Xie,X. Wang,D. T. Laskowitz,et al.Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time[J].EUROPEAN JOURNAL OF NEUROLOGY.2019,26(9):1168-+.doi:10.1111/ene.13961.
APA：
X. Xie,X. Wang,D. T. Laskowitz,X. Zhao,Z. Miao...&Y. Wang.(2019).Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time.EUROPEAN JOURNAL OF NEUROLOGY,26,(9)
MLA：
X. Xie,et al."Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time".EUROPEAN JOURNAL OF NEUROLOGY 26..9(2019):1168-+
