Table 1 . Comparison of study design and efficacy/safety outcomes of representative DAPT clinical trials 3 , 7 , 9 , 21 - 27 .
a The dosing regimen is based on local guidelines.
b The dosing regimen is based on Korean clinical practice (2011–2018).
ASA: acetylsalicylic acid; BID: twice-daily; Cilo: cilostazol; Clo: clopidogrel; DAPT: dual antiplatelet therapy; Dip: dipyridamole; HR: hazard ratio; ICH: intracerebral hemorrhage; LD: loading dose; ns: nonsignificant; QD: once-daily; SAH: subarachnoid hemorrhage; SAPT: single antiplatelet therapy; Tic: ticagrelor.
|
Trial |
DAPT a |
Initiation window |
Dosing regimen |
Follow-up |
Risk of ischemic stroke recurrence |
Risk of bleeding |
|
CHANCE |
Clo + ASA |
24 hours |
DAPT group: Day 1: Clo 300 mg (LD) + ASA 75–300 mg Days 2–21: Clo 75 mg + ASA 75 mg Days 22–90: Clo 75 mg SAPT group (ASA): Day 1: ASA 75–300 mg Days 2–90: ASA 75 mg |
90 days |
DAPT 7.9% vs. ASA 11.4%; HR 0.67, p < 0.001 |
Severe bleeding: DAPT 0.2% vs. ASA 0.2%; HR 0.94, p = 0.94 |
|
POINT |
Clo + ASA |
12 hours |
DAPT group: Day 1: Clo 600 mg (LD) + ASA 50–325 mg Days 2–90: Clo 75 mg + ASA 50–325 mg SAPT group (ASA): Days 1–90: ASA 50–325 mg |
90 days |
DAPT 4.6% vs. ASA 6.3%; HR 0.72, p = 0.01 |
Major bleeding: DAPT 0.9% vs. ASA 0.4%; HR 2.32, p = 0.02 |
|
THALES |
Tic + ASA |
24 hours |
DAPT group: Day 1: Tic 180 mg (LD) + ASA 300–325 mg Days 2–30: Tic 90 mg (BID) + ASA 75–100 mg SAPT group (ASA): Day 1: ASA 300–325 mg Days 2–30: ASA: 75–100 mg |
30 days |
DAPT 5.0% vs. ASA 6.3%; HR 0.79, p = 0.004 |
Severe hemorrhage: DAPT 0.5% vs. ASA 0.1%; HR 3.99, p = 0.001 |
|
CHANCE-2 |
Tic + ASA Clo + ASA |
24 hours |
DAPT group 1: Day 1: Tic 180 mg (LD) + ASA 75–300 mg Days 2–21: Tic 90 mg (BID) + ASA 75 mg Days 22–90: Tic 90 mg (BID) DAPT group 2: Day 1: Clo 300 mg (LD) + ASA 75–300 mg Days 2–21: Clo 75 mg + ASA 75 mg Days 22–90: Clo 75 mg |
90 days |
Tic + ASA 6.0% vs. Clo + ASA 7.6%; HR 0.77, p = 0.008 |
Severe or moderate bleeding: Tic + ASA 0.3% vs. Clo + ASA 0.3%; HR 0.82, p = 0.66 |
|
PROFESS |
Dip + ASA |
72 hours |
DAPT group: Days 1–90: Dip 200 mg (BID) + ASA 25 mg (BID) SAPT group (Clo): Days 1–90: Clo 75 mg |
90 days |
DAPT 7.7% vs. SAPT 7.9%; HR 0.97, p = ns |
Major bleeding: DAPT 4.1% vs. SAPT 3.6%; HR 1.15, p < 0.05 |
|
ADS |
Cilo + ASA |
48 hours |
DAPT group: Days 1–14: Cilo 200 mg + ASA 81–200 mg Days 15–90: Cilo 200 mg SAPT group (ASA and Cilo): Days 1–14: ASA 81–200 mg Days 15–90: Cilo 200 mg |
90 days |
DAPT 1% vs. SAPT 1%; p = 0.789 |
ICH: 0.2% in both groups; p = 0.999 SAH: DAPT 0.2% vs. SAPT 0%; p = 0.499 Serious extracranial hemorrhage: DAPT 0.3% vs. SAPT 0.2%; p = 0.624 |
|
CSPS.com |
Cilo + ASA |
8 days to 6 months |
DAPT group: Cilo 100 mg (BID) + ASA 81 or 100 mg/Clo 50 or 75 mg SAPT group (ASA or Clo): ASA 81 or 100 mg (QD) or Clo 50 or 75 mg (QD) |
3.5 years (median 1.4 years) |
DAPT 3% vs. SAPT 7%; HR 0.49, p = 0.001 |
Severe hemorrhage: DAPT 1% vs. SAPT 1%; HR 0.66, p = 0.35 |
|
Lee |
Clo + ASA |
24 hours |
DAPT group: Clo + ASA b SAPT group (ASA): ASA b |
90 days |
Ischemic stroke: DAPT 14.1% vs. SAPT 15.1%; p = 0.044 |
Hemorrhagic stroke: DAPT 0.38% vs. SAPT 0.23%; p = 0.148 |