CHANCE Trial

The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial tested the effect of early dual antiplatelet treatment for the prevention of secondary stroke within the first 90 days following a qualifying transient ischemic attack (TIA) or minor stroke in 5170 Chinese patients. The trial showed a significant reduction in secondary stroke in patients treated with dual antiplatelet therapy (hazard ratio, 0.68; 95% confidence interval, 0.57–0.81; P <0.001). There was no difference in the rate of moderate or severe hemorrhages (0.3% in both groups; P =0.73).1CHANCE is critical support for early-onset and short-term intervention of antiplatelet therapy in patients with TIAs and mild strokes. The trial builds on knowledge gained during the past decade, beginning with observations that the risks of stroke early after a TIA or minor stroke are substantial,2–4 with a 2-day risk of stroke following TIA of ≈5%.2,4 Greater attention has since been paid to early evaluation, identification, and treatment of modifiable risk factors and the initiation of antiplatelet treatment for noncardioembolic events within 48 hours of the initial event.5 Previous lysis and recanalization studies have shown the importance of immediate medical management following ischemic events. More recently, studies have addressed the use of antiplatelet agents in an earlier time window, seeking to address the period of highest stroke recurrence risk. The Fast Assessment of Stroke and Transient Ischaemic Attack to Prevent Early Recurrence (FASTER) pilot trial randomized 392 patients with TIA/stroke presenting within 24 hours to aspirin plus clopidogrel or aspirin plus placebo. There was a reduction of stroke within 90 days seen with dual therapy (absolute risk reduction, 3.8%; 95% confidence interval, −9.4 to 1.9; P =0.19) and no significant difference in bleeding events between treatment arms.5 …