Trial reportJournal of neurology2018
Aspirin plus clopidogrel may reduce the risk of early neurologic deterioration in ischemic stroke patients carrying CYP2C19*2 reduced-function alleles.
Trial report in Journal of neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06037889 (Efficacy and Safety of Tirofiban in Patients With Acute Branch Atheromatous Disease), which is not on this map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Efficacy and Safety of Tirofiban in Patients With Acute Branch Atheromatous Disease (BAD)- Related Stroke (BRANT)
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- The role ofExpert review of clinical pharmacology · 2022Pooled it
- Effects of PCSK9 inhibitor evolocumab on preventing early neurological deterioration in acute ischemic stroke patients with or without large artery atherosclerosis: a subgroup analysis of a randomized trial.BMC neurology · 2025 · on this mapTrial
- Baseline systolic blood pressure and efficacy of dual antiplatelet in acute ischaemic stroke.Stroke and vascular neurology · 2025Trial
- Early Neurologic Deterioration and Efficacy of Dual Antiplatelet in Anterior Versus Posterior Circulation Stroke.Journal of the American Heart Association · 2025Trial
- Dual Antiplatelet Therapy and Outcomes in Acute Mild to Moderate Stroke With Versus Without Large-Artery Atherosclerosis Post Hoc Analysis of ATAMIS.Journal of the American Heart Association · 2024Trial
- Article
- Diabetes mellitus and efficacy of dual antiplatelet in acute ischemic stroke: A post hoc analysis of the ATAMIS trial.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026Observational
- Residual early neurological deterioration following dual antiplatelet in stroke: post hoc analysis of the ATAMIS trial.Therapeutic advances in neurological disorders · 2026Article
- The effect of remote ischemic conditioning combined with tirofiban on early neurological deterioration in small artery occlusive stroke.BMC neurology · 2025Article
- Effect of age on the efficacy and safety of clopidogrel plus aspirin vs aspirin alone in acute mild-to-moderate stroke: a secondary analysis of the ATAMIS trial.Frontiers in neurology · 2025Article
- Early Neurological Deterioration and Time to Start Dual Antiplatelet Therapy in Patients With Acute Mild-to-Moderate Ischemic Stroke: A Pre-Specified Post Hoc Analysis of the ATAMIS Trial.Journal of stroke · 2024Article
- Article
- Prediction of early neurologic deterioration in patients with perforating artery territory infarction using machine learning: a retrospective study.Frontiers in neurology · 2024Article
- Review
- Serum neurofilament light chain levels are associated with early neurological deterioration in minor ischemic stroke.Frontiers in neurology · 2023Article
- Study protocol of Branch Atheromatous Disease-related stroke (BAD-study): a multicenter prospective cohort study.BMC neurology · 2022Article
- Targeting hypercoagulation to alleviate Alzheimer's disease progression in metabolic syndrome.International journal of obesity (2005) · 2022Review
- Review
- Ischemic stroke and myocardial ischemia in clopidogrel users and the association with CYP2C19 loss-of-function homozygocity: a real-world study.The pharmacogenomics journal · 2021Article
- Comparison of outcome of patients with acute minor ischaemic stroke treated with intravenous t-PA, DAPT or aspirin.Stroke and vascular neurology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe mechanisms of early neurologic deterioration (END) and prevention strategies for END are not completely understood. The aim of this study was to investigate the association between CYP2C19*2 variants and END, and the effectiveness of antiplatelet therapy for prevention of END according to CYP2C19*2 genotypes in patients with ischemic stroke (IS). MATERIALS AND
methodsThis was a two-center, randomized controlled study. Between August 2009 and December 2011, 570 IS patients were randomly assigned to clopidogrel plus aspirin group (n = 284) or aspirin alone group (n = 286). Platelet aggregation and platelet-leukocyte aggregates were measured before and after 7-10 days of treatment. CYP2C19*2 (rs4244285) genotypes were examined using mass spectrometry. The primary outcome was END during the 10 days of admission.
resultsAmong the 570 patients, 121 (21.2%) patients suffered from END. Carriers of CYP2C19*2 reduced-function alleles were associated with higher incidence of END (26.8% in carriers vs. 16.6% in noncarriers, P = 0.004). The incidence of END was lower in the clopidogrel plus aspirin group than in the aspirin alone group (17.6 vs. 24.8%, P = 0.032). Stratified analyses revealed that clopidogrel plus aspirin could be more effective in reducing END than aspirin alone for carriers of CYP2C19*2 reduced-function alleles (18.8 vs. 34.9%, P = 0.006). However, there was no significant difference in incidence of END between dual therapy group and monotherapy group for noncarriers (16.7 vs. 16.6%, P = 0.998).
conclusionsDual therapy with clopidogrel and aspirin may be adequate for prevention of END in carriers of CYP2C19 reduced-function alleles, but not for noncarriers. Our findings may be useful to guide precise antiplatelet therapy, and decrease the risk of END.
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Registered trials
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.