Glycated albumin predicts the effect of dual and single antiplatelet therapy on
recurrent stroke.
Author(s): Li J(1), Wang Y(1), Wang D(1), Lin J(1), Wang A(1), Zhao X(1), Liu L(1), Wang
C(1), Wang Y(2); CHANCE Investigators.
Affiliation(s): Author information:
(1)From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W.,
Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National
Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of
Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois
Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St.
Francis Healthcare System, University of Illinois College of Medicine, Peoria.
(2)From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W.,
Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National
Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of
Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois
Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St.
Francis Healthcare System, University of Illinois College of Medicine, Peoria.
yongjunwang1962@gmail.com.
Publication date & source: 2015, Neurology. , 84(13):1330-6
OBJECTIVE: To determine the relationship of glycated albumin (GA) and the
recurrence of stroke in patients on either dual or single antiplatelet therapy.
METHODS: The Clopidogrel in High-Risk Patients with Acute Nondisabling
Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to
antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of
3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified
clinical sites was analyzed. Patients were categorized into 2 groups based on GA
level of 15.5%, the cut point for development of diabetes. The primary outcome
was stroke recurrence during 90-day follow-up. Cox proportional hazards models
were used to assess the interaction of GA with randomized antiplatelet therapy on
their risk of recurrent stroke.
RESULTS: Significant interaction of GA levels with the 2 antiplatelet therapy
groups was found after adjustment for age, sex, and other conventional
confounding factors (p = 0.009). The interaction remained consistent after
further adjustment for history of diabetes (p = 0.010). In patients with lower GA
level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and
12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence
interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA
level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and
11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103).
CONCLUSIONS: GA could be a potential biomarker to predict the effects of dual and
single antiplatelet therapy in patients with minor stroke or TIA.
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