Annals of Neurology: Tiantan Hospital, after mild stroke, double antiplatelet therapy, what is the bleeding risk?

In CHANCE (clopidogrel in high-risk patients with acute nondisabling cerebrovascular events), dual antiplatelet therapy with clopidogrel-aspirin or ticagrelor-aspirin has been shown to be more effective than aspirin alone in reducing stroke or Subsequent events in patients with transient ischemic attack (TIA) were more effective

POINT (platelet-directed inhibition in new-onset TIA and minor ischemic stroke) and THALES (ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA) trials

The CHANCE-2 trial showed that ticagrelor-aspirin was superior to clopidogrel-aspirin in reducing stroke risk in Chinese patients with minor ischemic stroke or TIA in CYP2C19 loss-of-function (LOF) allele carriers

However, bleeding events are the most important side effect in patients taking antithrombotic drugs

Uncertainty remains about the bleeding profile and risk factors associated with bleeding events in patients receiving dual antiplatelet therapy

In this context, Anxin Wang et al at Tiantan Hospital, a post hoc analysis of the CHANCE-2 trial, aimed to describe the use of alternatives in patients with mild stroke or TIA carrying the CYP2C19 LOF allele that reduces the conversion of clopidogrel to the active form.

A total of 6412 patients were enrolled from the CHANCE-2 (clopidogrel and aspirin in patients at high risk of acute nondisabling cerebrovascular events II) trial

A total of 250 (3.

Minor bleeding such as skin bruising, epistaxis, and bleeding gums are the most common

Current smoking was associated with a lower risk of bleeding (HR = 0.

The study's core conclusion is that most bleeding events occurred during the 21-day dual antiplatelet therapy phase and were generally mild