CHANCE Trial (2013): Clopidogrel with aspirin in acute minor stroke or transient ischemic attack

CHANCE Trial Visual Summary

CHANCE Trial Summary: Wang et al. randomized 5,170 patients (≥40 years) with either minor ischemic stroke (NIHSS score ≤3) or high-risk TIA (ABCD2 score ≥4) to either aspirin/clopidogrel combination or aspirin alone. The primary objective was to assess if early administration of aspirin/clopidogrel reduces rates of subsequent strokes when compared to aspirin monotherapy in patients with acute TIA or minor ischemic stroke.

The results showed a significant decrease in recurrence of stroke (P<0.001; NNT=29). Bleeding risk did not show a significant difference between both groups (P=0.09). The results were based on Chinese population. In 2018, the POINT trial studied similar outcomes and showed an increased risk of bleeding with dual antiplatelet therapy.

The authors of the CHANCE trial concluded that in patients with minor ischemic stroke or high-risk TIA, starting aspirin/clopidogrel within 24h of symptom onset reduces the 90-day stroke incidence without increasing bleeding rates, when compared to aspirin monotherapy.

Source: NEJM