Evidence map›Paper›PMID 29766750›Full record

Trial reportThe New England journal of medicine2018

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.

S Claiborne Johnston, J Donald Easton, Mary Farrant, William Barsan, Robin A Conwit, Jordan J Elm, Anthony S Kim, Anne S Lindblad, Yuko Y Palesch, Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators

11 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 11 registered trials, which are not on this map. Cited by 537 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
537citing papers in PubMed, 21 pooled it
88.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05001984 phase2active not recruitingstarted 2021, after this paper: background citation

Trial of PCSK9 Inhibition in Patients with Acute Stroke and Symptomatic Intracranial Atherosclerosis - a Prospective, Randomized, Open-label, Blinded End-point Study with High-resolution MR Vessel Wall Imaging

Ran2021Enrolled60Registered outcomes11Posted comparisons0ConditionsAcute Ischemic Stroke, ICAS - Intracranial Atherosclerosis, Intracranial AtherosclerosisArmsAlirocumab
PMID 30403574PMID 25824512PMID 16899775PMID 22568537PMID 30932785PMID 30586774PMID 28675189PMID 26671513PMID 24481975PMID 24222016PMID 24135208PMID 23803136other papers from this trial
Open the trial in the graph
NCT00991029 phase3terminatednot on this map

Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial

TypeinterventionalSponsorUniversity of California, San FranciscoRan2010 to 2018Enrolled4,881ConditionsIschemic Attack, TransientArmsClopidogrel, placebo
NCT04824911 phase2completednot on this mapstarted 2021, after this paper: background citation

Early Intensive Medical Therapy for the Prevention of Early Neurological Deterioration in Branch Atheromatous Disease

TypeinterventionalSponsorChang Gung Memorial HospitalRan2021 to 2025Enrolled376ConditionsAcute Stroke, Dual Antiplatelet Therapy, StatinArmsClopidogrel, Aspirin, Atorvastatin, Rosuvastatin
NCT05476081 completednot on this mapstarted 2021, after this paper: background citation

A REAl-life Study on Short-term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack

Typeobservational_patient_registrySponsorUniversity of L'AquilaRan2021 to 2023Enrolled2,239ConditionsIschemic Stroke, TIAArmsAspirin, Clopidogrel, Ticagrelor
NCT05763862 naactive not recruitingnot on this mapstarted 2023, after this paper: background citation

Genotype Guided Antiplatelet Therapy In Ischemic Stroke

TypeinterventionalSponsorNational Neuroscience InstituteRan2023 to 2026Enrolled350ConditionsIschemic Stroke, Transient Ischemic AttackArmsGenetic testing
NCT05995600 phase4recruitingnot on this mapstarted 2024, after this paper: background citation

Comparison of Clopidogrel-based Antiplatelet Therapy Versus Warfarin As Secondary Prevention Strategy for AntiPhospholipid Syndrome-related STROKE (APS-STROKE)

TypeinterventionalSponsorSeoul National University HospitalRan2024 to 2029Enrolled200ConditionsAntiphospholipid Syndrome, Ischemic Stroke, Transient Ischemic Attack, Cerebrovascular DiseaseArmsAntiplatelet Drug, Warfarin
NCT06243133 phase4unknown statusnot on this mapstarted 2024, after this paper: background citation

Pair Antiplatelet THerapy in Ischemic Stroke With Intracranial Artery Stenosis

TypeinterventionalSponsorSichuan Provincial People's HospitalRan2024 to 2026Enrolled1,100ConditionsIschemic Stroke, Intracranial Arteriosclerosis, Secondary Prevention, Antiplatelet DrugArmsclopidogrel for 90 days combined with aspirin for 90 days, clopidogrel for 30 days combined with aspirin for 90 days
NCT06404242 recruitingnot on this mapstarted 2024, after this paper: background citation

Plaque Characteristics From Vessel Wall Magnetic Resonance Imaging Predict Recurrent Stroke in Ischemic Stroke Patients Due to Middle Cerebral Artery Stenosis

TypeobservationalSponsorUniversity Medical Center Ho Chi Minh City (UMC)Ran2024 to 2026Enrolled75ConditionsHigh Resolution Vessel Wall Imaging, Recurrent Stroke, Stroke, Mechanism, Atheroscleroses, Intracranial
NCT06823999 phase4not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Effect of Vitamin C in the Prevention and Treatment for Bruises in Patients With Ischemic Stroke: A Double-blind Randomized Control Trial

TypeinterventionalSponsorChiayi Christian HospitalRan2025 to 2028Enrolled400ConditionsStroke, Bruises, Skin LesionsArmsAscorbic acid (Vitamin C), Normal Saline (Placebo)
NCT07174414 phase3not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Cilostazol for Prevention of Recurrent Stroke Trial

TypeinterventionalSponsorStanford UniversityRan2026 to 2031Enrolled2,000ConditionsStroke Recurrence, Myocardial Infarction, Vascular Death, Ischemic StrokeArmsCilostazol 100 mg, Placebo
NCT07644234 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Platelet Aggregation Function-Guided De-Escalation Antiplatelet Therapy in Patients With Acute Ischemic Stroke

TypeinterventionalSponsorSichuan Provincial People's HospitalRan2026 to 2029Enrolled3,836ConditionsIschemic Stroke, Transient Ischemic AttackArmsClopidogrel, Aspirin
3 · Its place in the literature

Who cites it

537 citing papers in PubMed, 21 syntheses or guidelines pooled it, 1,288 citations in OpenAlex.

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  3. Interaction of CYP2C19 with the effect of clopidogrel in secondary prevention of major ischemic events: Systematic review and meta-analysis.International journal of stroke : official journal of the International Stroke Society · 2026
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477 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 1 country.

S Claiborne JohnstonFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
J Donald EastonFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Mary FarrantFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
William BarsanFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Robin A ConwitFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Jordan J ElmFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Anthony S KimFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Anne S LindbladFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Yuko Y PaleschFrom the Dean's Office, Dell Medical School, University of Texas at Austin, Austin (S.C.J.); the Department of Neurology, University of California, San Francisco, San Francisco (J.D.E., M.F., A.S.K.); the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.); the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda (R.A.C.), and Emmes, Rockville (A.S.L.) - both in Maryland; and the Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E., Y.Y.P.).
Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators
University of California, San Francisco · USMedical University of South Carolina · USEmmes (United States) · USNational Institute of Neurological Disorders and Stroke · USThe University of Texas at Austin · USUniversity of Michigan–Ann Arbor · US

Funding

POINT: PLATELET-ORIENTED INHIBITION IN NEW TIAU01NS062835 · NINDS · UNIVERSITY OF TEXAS AT AUSTIN · PI EASTON, J. DONALD, ELM, JORDAN J. · 2009 to 2017
$56.0M
Neurologic Emergencies Treatment Trials Network: Clinical Coordinating CenterU01NS056975 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BARSAN, WILLIAM G · 2006 to 2015
$40.4M
Harvard Clinical and Translational Science Center (UL1)UL1TR000170 · NCATS · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2012 to 2013
$31.4M
Neurological Emergencies Treatment Trials Network Statistical and Data ManagementU01NS059041 · NINDS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI DURKALSKI, VALERIE L, PALESCH, YUKO Y · 2006 to 2015
$9.1M
NCATS NIH HHS UL1 TR000170NINDS NIH HHS U01 NS056975NINDS NIH HHS U01 NS059041NINDS NIH HHS U01 NS062835
6 · The paper itself

Abstract

backgroundCombination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.

methodsIn a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone. The dose of aspirin in each group was selected by the site investigator. The primary efficacy outcome in a time-to-event analysis was the risk of a composite of major ischemic events, which was defined as ischemic stroke, myocardial infarction, or death from an ischemic vascular event, at 90 days.

resultsA total of 4881 patients were enrolled at 269 international sites. The trial was halted after 84% of the anticipated number of patients had been enrolled because the data and safety monitoring board had determined that the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events and a higher risk of major hemorrhage than aspirin alone at 90 days. Major ischemic events occurred in 121 of 2432 patients (5.0%) receiving clopidogrel plus aspirin and in 160 of 2449 patients (6.5%) receiving aspirin plus placebo (hazard ratio, 0.75; 95% confidence interval [CI], 0.59 to 0.95; P=0.02), with most events occurring during the first week after the initial event. Major hemorrhage occurred in 23 patients (0.9%) receiving clopidogrel plus aspirin and in 10 patients (0.4%) receiving aspirin plus placebo (hazard ratio, 2.32; 95% CI, 1.10 to 4.87; P=0.02).

conclusionsIn patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone. (Funded by the National Institute of Neurological Disorders and Stroke; POINT ClinicalTrials.gov number, NCT00991029 .).

Indexed as

Secondary PreventionAgedAspirinBrain IschemiaClopidogrelDouble-Blind MethodDrug Therapy, CombinationFemaleHemorrhageHumansIschemiaIschemic Attack, TransientMaleMiddle AgedMyocardial InfarctionPlatelet Aggregation InhibitorsAspirinClopidogrelPlatelet Aggregation InhibitorsTiclopidine

Identifiers

PMID29766750
PMCPMC6193486
OpenAlexW2804570339

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

and 5 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.