Antiplatelets for secondary stroke prevention in China.

Platelets are the primary target of antithrombotic therapy to prevent cardiovascular events due to their essential role in atherothrombosis. In patients who have had a recent non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA), aspirin (an irreversible cyclo-oxygenase inhibitor that suppresses the synthesis of thromboxane A2) and clopidogrel (a thienopyridine that blocks the adenosine diphosphate receptor P2RY12) are often used alone or in combination to block platelet aggregation for the prevention of recurrent stroke and other major cardiovascular events. However, as these drugs have modest beneficial effects and increase the risk of major haemorrhage, in particular intracranial haemorrhage, new and different combinations of antiplatelet agents are needed to improve effectiveness and safety. These issues are particularly pertinent to patients with ischaemic stroke in China, where resistance to clopidogrel from genetic mutation in CYP2C19, delayed presentation after the onset of symptoms, little access to modern reperfusion therapy, and high rates of primary intracerebral haemorrhage from unsatisfactory control of hypertension are common factors that influence the choice of antiplatelet therapy. In The Lancet Neurology, Yuesong Pan and colleagues present results of the first clinical trial to establish if indobufen, a reversible cyclo-oxygenase inhibitor with short-term effects on platelet aggregation, 1 Lee JY Sung KC Choi HI Comparison of aspirin and indobufen in healthy volunteers. Platelets. 2016; 27: 105-109 PubMed Google Scholar could offer a safer alternative to aspirin to reduce the risk of early recurrent ischaemic stroke. 2 Pan Y Meng X Yuan B et al. Indobufen versus aspirin in patients with acute ischaemic stroke in China (INSURE): a randomised, double-blind, double-dummy, active control, non-inferiority trial. Lancet Neurol. 2023; (published online April 27.)https://doi.org/10.1016/S1474-4422(23)00113-8 Summary Full Text Full Text PDF Scopus (1) Google Scholar Indobufen versus aspirin in patients with acute ischaemic stroke in China (INSURE): a randomised, double-blind, double-dummy, active control, non-inferiority trialIn patients with acute moderate-to-severe ischaemic stroke, indobufen was not non-inferior to aspirin because the upper limit of the 95% CI was greater than 1·25. Furthermore, indobufen seemed to be inferior to aspirin in reducing the risk of recurrent stroke at 90 days because the lower limit of the 95% CI was greater than 1·00. Although moderate or severe bleeding did not differ between groups, these findings do not support the use of indobufen for secondary stroke prevention in patients with moderate-to-severe ischaemic stroke. Full-Text PDF