• Xianwei Wang, Xingquan Zhao, S Claiborne Johnston, Ying Xian, Bo Hu, Chunxue Wang, David Wang, Liping Liu, Hao Li, Jiming Fang, Xia Meng, Anxin Wang, Yongjun Wang, Yilong Wang, and CHANCE investigators.
• From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada.
• Neurology. 2015 Aug 18; 85 (7): 573-9.

ObjectiveWe compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA.MethodsParticipants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less.ResultsPoor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups.ConclusionsIn patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm.Classification Of EvidenceThis study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%-3.42%).© 2015 American Academy of Neurology.

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