Background No study has thoroughly compared the effectiveness of combined antiplatelet treatments (other than clopidogrel–aspirin) versus clopidogrel–aspirin or aspirin alone for early secondary prevention in acute ischaemic stroke. Methods We identified patients with acute, minor, non-cardiogenic ischaemic stroke treated with aspirin alone, clopidogrel–aspirin or other combination treatment. Propensity scores considering the inverse probability of treatment weighting were used to adjust for baseline imbalances. The primary outcome was the composite of all strokes (ischaemic or haemorrhagic), myocardial infarction and all-cause mortality at 3 months. Results Among 12 234 patients (male: 61.9%; age: 65.5±13 years) who met the eligibility criteria, aspirin, clopidogrel–aspirin and other combination treatments were administered in 52.2%, 42.9% and 4.9% of patients, respectively. In the crude analysis, the primary outcome event at 3 months occurred in 14.5% of the other combination group, 14.4% of the aspirin group and 13.0% of the clopidogrel–aspirin group. In the weighted Cox proportional hazards analysis, the 3-month primary outcome event occurred less frequently in the clopidogrel–aspirin group than in the other combination group (weighted HR: 0.82 (0.59–1.13)), while no association was found between the aspirin group (weighted HR: 1.04 (0.76–1.44)) or other combination group and the 3-month primary outcome. Conclusion Other combined antiplatelet treatment, compared with aspirin alone or clopidogrel–aspirin, was not associated with reduced risks of primary composite vascular events or recurrent stroke during the first 3 months after stroke. Therefore, the results suggest that other combination treatments, particularly the cilostazol-based combination, may not be effective alternatives for clopidogrel–aspirin to prevent early vascular events in patients with acute minor stroke. Further exploration in clinical trials will be needed. Data are available upon reasonable request. The CRCS-K research committee will provide the data, analytic methods and study materials to other researchers upon reasonable request.

中文翻译：

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急性轻度缺血性卒中联合抗血小板治疗的疗效比较

背景 没有研究彻底比较联合抗血小板治疗（氯吡格雷-阿司匹林除外）与氯吡格雷-阿司匹林或单独阿司匹林在急性缺血性卒中早期二级预防中的有效性。方法 我们确定了接受单独阿司匹林、氯吡格雷-阿司匹林或其他联合治疗的急性、轻微、非心源性缺血性卒中患者。考虑到治疗加权的逆概率的倾向评分用于调整基线不平衡。主要结果是 3 个月时所有中风（缺血性或出血性）、心肌梗死和全因死亡率的复合。结果在符合入选标准的12 234例患者（男性：61.9%；年龄：65.5±13岁）中，阿司匹林、氯吡格雷-阿司匹林等联合治疗组分别占52.2%、42.9%和4例。分别为 9% 的患者。在粗略分析中，3 个月时的主要结局事件发生在其他联合组的 14.5%、阿司匹林组的 14.4% 和氯吡格雷-阿司匹林组的 13.0%。在加权 Cox 比例风险分析中，氯吡格雷-阿司匹林组 3 个月主要结局事件的发生频率低于其他联合组（加权 HR：0.82 (0.59-1.13)），而阿司匹林之间未发现相关性组（加权 HR：1.04 (0.76–1.44)）或其他组合组和 3 个月的主要结果。结论 与单用阿司匹林或氯吡格雷-阿司匹林相比，其他联合抗血小板治疗与卒中后前 3 个月内原发性复合血管事件或复发性卒中风险降低无关。所以，结果表明，其他联合治疗，特别是基于西洛他唑的联合治疗，可能不是氯吡格雷-阿司匹林预防急性轻度卒中患者早期血管事件的有效替代品。需要在临床试验中进一步探索。可根据合理要求提供数据。CRCS-K研究委员会将根据合理要求向其他研究人员提供数据、分析方法和研究材料。