Evidence map›Paper›PMID 25468508›Full record

Trial reportBMJ open2014

Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.

Meng Lee, Yi-Ling Wu, Jeffrey L Saver, Hsuei-Chen Lee, Jiann-Der Lee, Ku-Chou Chang, Chih-Ying Wu, Tsong-Hai Lee, Hui-Hsuan Wang, Neal M Rao and 1 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Drugs in secondary stroke prevention.Australian prescriber · 2021
    Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Meng LeeDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan.
Yi-Ling WuDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan.
Jeffrey L SaverDepartment of Neurology, Stroke Center, Geffen School of Medicine, University of California, Los Angeles, California, USA.
Hsuei-Chen LeeDepartment of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
Jiann-Der LeeDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan.
Ku-Chou ChangDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan.
Chih-Ying WuDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan.
Tsong-Hai LeeDepartment of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Hui-Hsuan WangDepartment of Healthcare Management, Chang Gung University, Taoyuan, Taiwan.
Neal M RaoDepartment of Neurology, Stroke Center, Geffen School of Medicine, University of California, Los Angeles, California, USA.
Bruce OvbiageleDepartment of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThere is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke.

designRetrospective.

settingWe conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database.

participantsAmong 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio <80%. Also, 355 were excluded due to history of atrial fibrillation, valvular heart disease or coagulopathy. Therefore, 1884 patients were included in our final analysis.

interventionsPatients were categorised into two groups based on whether clopidogrel or aspirin was prescribed during the follow-up period. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction, death or the end of 2010. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary end point was hospitalisation due to a new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke.

resultsCompared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates.

conclusionsAmong patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation.

Indexed as

AgedAspirinBrain IschemiaClopidogrelDose-Response Relationship, DrugFemaleFollow-Up StudiesHospitalizationHumansIncidenceMalePlatelet Aggregation InhibitorsRecurrenceRetrospective StudiesSurvival RateTaiwanAspirinClopidogrelPlatelet Aggregation InhibitorsTiclopidineCLINICAL PHARMACOLOGYEPIDEMIOLOGY

Identifiers

PMID25468508
PMCPMC4256539

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.