Disability After Minor Stroke and Transient Ischemic Attack in the POINT Trial

Brett Cucchiara, Jordan Elm, J. Donald Easton, Shelagh B. Coutts, Joshua Z. Willey, Michelle H. Biros, Michael A. Ross, S. Claiborne Johnston

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31 Scopus citations

Abstract

Background and Purpose - While combination aspirin and clopidogrel reduces recurrent stroke compared with aspirin alone in patients with transient ischemic attack (TIA) or minor stroke, the effect on disability is uncertain. Methods - The POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) randomized patients with TIA or minor stroke (National Institutes of Health Stroke Scale score ≤3) within 12 hours of onset to dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel versus aspirin alone. The primary outcome measure was a composite of stroke, myocardial infarction, or vascular death. We performed a post hoc exploratory analysis to examine the effect of treatment on overall disability (defined as modified Rankin Scale score >1) at 90 days, as well as disability ascribed by the local investigator to index or recurrent stroke. We also evaluated predictors of disability. Results - At 90 days, 188 of 1964 (9.6%) of patients enrolled with TIA and 471 of 2586 (18.2%) of those enrolled with stroke were disabled. Overall disability was similar between patients assigned DAPT versus aspirin alone (14.7% versus 14.3%; odds ratio, 0.97 [95% CI, 0.82-1.14]; P=0.69). However, there were numerically fewer patients with disability in conjunction with a primary outcome event in the DAPT arm (3.0% versus 4.0%; odds ratio, 0.73 [95% CI, 0.53-1.01]; P=0.06) and significantly fewer patients in the DAPT arm with disability attributed by the investigators to either the index event or recurrent stroke (5.9% versus 7.4%; odds ratio, 0.78 [95% CI, 0.62-0.99]; P=0.04). Notably, disability attributed to the index event accounted for the majority of this difference (4.5% versus 6.0%; odds ratio, 0.74 [95% CI, 0.57-0.96]; P=0.02). In multivariate analysis, age, subsequent ischemic stroke, serious adverse events, and major bleeding were significantly associated with disability in TIA; for those with stroke, female sex, hypertension, or diabetes mellitus, National Institutes of Health Stroke Scale score, recurrent ischemic stroke, subsequent myocardial infarction, and serious adverse events were associated with disability. Conclusions - In addition to reducing recurrent stroke in patients with acute minor stroke and TIA, DAPT might reduce stroke-related disability. Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00991029.

Original languageEnglish (US)
Pages (from-to)792-799
Number of pages8
JournalStroke
Volume51
Issue number3
DOIs
StatePublished - Mar 1 2020

Bibliographical note

Funding Information:
This trial was supported by grants from the National Institute for Neurological Disorders and Stroke, National Institutes of Health (U01 NS062835, U01 NS056975, and U01 NS059041). The sponsor had no role in the design, conduct, analysis, or presentation of the study. Sanofi provided drug and placebo for 75% of patients in the trial.

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • Aspirin
  • Diabetes mellitus
  • Humans
  • Ischemic attack
  • Stroke
  • Transient
  • Disability Evaluation
  • Predictive Value of Tests
  • Recurrence
  • Stroke/complications
  • Intracranial Hemorrhages/complications
  • Double-Blind Method
  • Platelet Aggregation Inhibitors/therapeutic use
  • Middle Aged
  • Myocardial Infarction/complications
  • Risk Factors
  • Aspirin/therapeutic use
  • Male
  • Treatment Outcome
  • Clopidogrel/therapeutic use
  • Sex Factors
  • Female
  • Aged
  • Ischemic Attack, Transient/epidemiology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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