6/28/23, 12:05 AM CHANCE Pathway Feedback Search Clinical Topics Home Studies CHANCE CHANCE Disease Disease Acute ischemic stroke Transient ischemic attack Trial question What is the role of combination of clopidogrel with aspirin in patients with acute minor stroke or TIA? Study design Multi-center Double blinded RCT Population Characteristics of study participants 34.0% female N = 5170 66.0% male 5170 patients (1750 female, 3420 male) Inclusion criteria: patients after the onset of minor ischemic stroke or high-risk TIA Key exclusion criteria: hemorrhage, VM, tumor, abscess, isolated sensory symptoms (e.g., numbness), isolated visual changes, or isolated dizziness or vertigo without evidence of acute infarction on baseline CT or MRI of the head Interventions N=2584 clopidogrel-aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) N=2586 aspirin alone (placebo plus aspirin 75 mg per day for 90 days) Primary outcome Stroke 11.7 % 11.7 https://web.pathway.md/studies/recrMgxz2ZUkVIBus 1/2 6/28/23, 12:05 AM CHANCE Pathway 8.8 % 8.2 5.8 % Significant decrease 2.9 % NNT = 29 0.0 % Clopidogrel-aspirin Aspirin alone Significant decrease in stroke (8.2% vs. 11.7%; HR 0.68, 95% CI 0.57 to 0.81) Secondary outcomes Significant decrease in vascular events (8.4% vs. 11.9%; HR 0.69, 95% CI 0.58 to 0.82) Significant decrease in ischemic stroke (7.9% vs. 11.4%; HR 0.67, 95% CI 0.56 to 0.81) No significant difference in hemorrhagic stroke (0.3% vs. 0.3%; HR 1.01, 95% CI 0.38 to 2.7) Safety outcomes No significant differences in adverse events (5.8% vs. 5.0%) and serious adverse events (1.0% vs. 0.8%) and moderate or severe hemorrhage (0.3% vs. 0.3%, p=0.73). Significant differences in any bleeding (2.3% vs. 1.6%, p = 0.09). Conclusion In patients after the onset of minor ischemic stroke or high-risk TIA, clopidogrel-aspirin was superior to aspirin alone with respect to stroke. Reference Wang Y, Wang Y, Zhao X et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013 Jul 4;369(1):11-9. Open reference URL https://web.pathway.md/studies/recrMgxz2ZUkVIBus 2/2