Clopidogrel in High-risk Patients With Acute Non-disabling Cerebrovascular Events

Summary

The purpose of this study is to assess the effects of a 3-month regimen of clopidogrel initiated with a loading dose (LD) of 300 mg followed by 75 mg/day during the first 21days versus a 3-month regimen of ASA 75 mg/day alone on reducing the 3-month risk of any stroke (both ischemic and hemorrhagic, primary outcome) when initiated within 24 hours of symptom onset in high-risk patients with TIA or minor stroke.

Timeline

Start

2009-12

Primary completion

2012-03

Completion

2012-06

Publications

• Background Wang Y, Johnston SC; CHANCE Investigators. Rationale and design of a randomized, double-blind trial comparing the effects of a 3-month clopidogrel-aspirin regimen versus aspirin alone for the treatment of high-risk patients with acute nondisabling cerebrovascular event. Am Heart J. 2010 Sep;160(3):380-386.e1. doi: 10.1016/j.ahj.2010.05.017.
• Background Wang Y, Zhao X, Lin J, Li H, Johnston SC, Lin Y, Pan Y, Liu L, Wang D, Wang C, Meng X, Xu J, Wang Y; CHANCE investigators. Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack. JAMA. 2016 Jul 5;316(1):70-8. doi: 10.1001/jama.2016.8662.
• Background Jing J, Meng X, Zhao X, Liu L, Wang A, Pan Y, Li H, Wang D, Johnston SC, Wang Y, Wang Y. Dual Antiplatelet Therapy in Transient Ischemic Attack and Minor Stroke With Different Infarction Patterns: Subgroup Analysis of the CHANCE Randomized Clinical Trial. JAMA Neurol. 2018 Jun 1;75(6):711-719. doi: 10.1001/jamaneurol.2018.0247.
• Background Pan Y, Elm JJ, Li H, Easton JD, Wang Y, Farrant M, Meng X, Kim AS, Zhao X, Meurer WJ, Liu L, Dietrich D, Wang Y, Johnston SC. Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack: A Pooled Analysis of Clopidogrel in High-Risk Patients With Acute Non-Disabling Cerebrovascular Events (CHANCE) and Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trials. JAMA Neurol. 2019 Dec 1;76(12):1466-1473. doi: 10.1001/jamaneurol.2019.2531.
• Background Pan Y, Meng X, Jing J, Li H, Zhao X, Liu L, Wang D, Johnston SC, Wang Y, Wang Y; CHANCE Investigators. Association of multiple infarctions and ICAS with outcomes of minor stroke and TIA. Neurology. 2017 Mar 14;88(11):1081-1088. doi: 10.1212/WNL.0000000000003719. Epub 2017 Feb 15.
• Background Pan Y, Jing J, Chen W, Meng X, Li H, Zhao X, Liu L, Wang D, Johnston SC, Wang Y, Wang Y; CHANCE investigators. Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE. Neurology. 2017 May 16;88(20):1906-1911. doi: 10.1212/WNL.0000000000003941. Epub 2017 Apr 19.
• Background Li J, Wang A, Zhao X, Liu L, Meng X, Lin J, Jing J, Zou X, Wang Y, Wang Y; CHANCE Investigators. High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis. Neurology. 2018 Feb 6;90(6):e447-e454. doi: 10.1212/WNL.0000000000004928. Epub 2018 Jan 12.
• Results Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013 Jul 4;369(1):11-9. doi: 10.1056/NEJMoa1215340. Epub 2013 Jun 26.
• Han C, Yang M, Pan Y, Li H, Liu L, Meng X, Wang Y, Wang Y. Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke. J Am Heart Assoc. 2025 Apr 15;14(8):e029734. doi: 10.1161/JAHA.122.029734. Epub 2025 Apr 7.
• Qiu X, Jiang Y, Gu HQ, Jiang Y, Huang X, Meng X, Wang Y, Li Z. Polygenic Risk Score for the Efficacy of Clopidogrel in Patients With Minor Stroke or Transient Ischemic Attack: A Post Hoc Analysis of the CHANCE Trial. Stroke. 2025 Apr;56(4):818-827. doi: 10.1161/STROKEAHA.124.049140. Epub 2025 Mar 7.
• Yang M, Xu J, Xue J, Pan Y, Cheng A, Gao F, Meng X, Miao Z, Wang Y, Wang Y; CHANCE Investigators. Efficacy of dual antiplatelet therapy after ischemic stroke according to hsCRP levels and CYP2C19 genotype. Am Heart J. 2025 Feb;280:89-97. doi: 10.1016/j.ahj.2024.10.017. Epub 2024 Nov 12.
• Qiu X, Zhang Y, Gu H, Jiang Y, Pan Y, Jiang Y, Meng X, Wang Y, Zhao X, Li H, Wang X, Wang Y, Li Z; CHANCE Investigators. Association Between CYP2B6 Polymorphisms and Efficacy of Clopidogrel in Minor Stroke or Transient Ischemic Attack. Stroke. 2023 Jul;54(7):1770-1776. doi: 10.1161/STROKEAHA.122.040507. Epub 2023 Jun 2.
• Chen P, Wu Q, Xie X, Jing J, Gu H, Wang X, Meng X, Liu L, Wang Y, Wang Y; CHANCE Investigators. Systolic blood pressure and recurrent stroke in patients with different lesion patterns on diffusion weighted imaging. J Clin Hypertens (Greenwich). 2022 Oct;24(10):1350-1357. doi: 10.1111/jch.14543. Epub 2022 Aug 12.
• Zhang X, Jing J, Zhao X, Liu L, Wang A, Pan Y, Wang D, Johnston SC, Wang Y, Wang Y, Meng X. No rebound effect after a course of clopidogrel in patients with acute TIA or minor stroke. Neurol Res. 2022 Nov;44(11):957-963. doi: 10.1080/01616412.2022.2075660. Epub 2022 Jun 13.
• Pan Y, Wangqin R, Li H, Jin A, Li J, Lin J, Meng X, Xian Y, Laskowitz DT, Wang Y. LDL-C levels, lipid-lowering treatment and recurrent stroke in minor ischaemic stroke or TIA. Stroke Vasc Neurol. 2022 Aug;7(4):276-284. doi: 10.1136/svn-2021-001317. Epub 2022 Mar 7.
• Natale P, Palmer SC, Saglimbene VM, Ruospo M, Razavian M, Craig JC, Jardine MJ, Webster AC, Strippoli GF. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev. 2022 Feb 28;2(2):CD008834. doi: 10.1002/14651858.CD008834.pub4.
• Pan Y, Wangqin R, Li H, Wang Y, Meng X, Johnston SC, Simon T, Lin J, Zhao X, Liu L, Wang D, Wang Y. F2R Polymorphisms and Clopidogrel Efficacy and Safety in Patients With Minor Stroke or TIA. Neurology. 2021 Jan 5;96(1):e1-e9. doi: 10.1212/WNL.0000000000011078. Epub 2020 Oct 22.
• Wang G, Jing J, Li J, Pan Y, Yan H, Meng X, Zhao X, Liu L, Li H, Wang DZ, Wang Y, Wang Y. Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial. Stroke Vasc Neurol. 2021 Mar;6(1):80-86. doi: 10.1136/svn-2020-000369. Epub 2020 Sep 21.
• Chen H, Pan Y, Zong L, Jing J, Meng X, Xu Y, Yan H, Zhao X, Liu L, Li H, Johnston SC, Wang Y, Wang Y. Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. Stroke Vasc Neurol. 2020 Jun;5(2):128-137. doi: 10.1136/svn-2019-000305. Epub 2020 Apr 15.
• Xu YY, Zong LX, Zhang CQ, Pan YS, Jing J, Meng X, Li H, Zhao XQ, Liu LP, Wang D, Wang YL, Wang YJ; CHANCE Investigators. The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients. Ann Transl Med. 2020 Mar;8(6):331. doi: 10.21037/atm.2020.02.137.
• Li J, Wang Y, Li H, Zuo Z, Lin J, Wang A, Zhao X, Liu L, Wang Y; CHANCE Investigators. Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack: Subanalysis of the CHANCE Trial. Arterioscler Thromb Vasc Biol. 2020 Mar;40(3):839-846. doi: 10.1161/ATVBAHA.119.313741. Epub 2020 Jan 16.
• Yang M, Wang A, Li J, Zhao X, Liu L, Meng X, Jing J, Zhang N, Johnston SC, Wang Y, Wang Y. Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis. Neurology. 2020 Jan 14;94(2):e181-e189. doi: 10.1212/WNL.0000000000008733. Epub 2019 Dec 10.
• Mo J, Chen Z, Xu J, Wang A, Dai L, Cheng A, Meng X, Li H, Wang Y; CHANCE Investigators. Efficacy of Clopidogrel-Aspirin Therapy for Stroke Does Not Exist in CYP2C19 Loss-of-Function Allele Noncarriers With Overweight/Obesity. Stroke. 2020 Jan;51(1):224-231. doi: 10.1161/STROKEAHA.119.026845. Epub 2019 Nov 15.
• Chen W, Pan Y, Jing J, Zhao X, Liu L, Meng X, Wang Y, Lin Y, Wang Y; CHANCE Investigators. Association of Body Mass Index and Risk of Stroke After Acute Minor Stroke or TIA: a Post Hoc Analysis of a Randomized Controlled Trial. Neurotox Res. 2019 Nov;36(4):836-843. doi: 10.1007/s12640-019-00056-4. Epub 2019 May 24.
• Xie X, Wang X, Laskowitz DT, Zhao X, Miao Z, Liu L, Li H, Meng X, Wang Y, Wang Y; CHANCE investigators. Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time. Eur J Neurol. 2019 Sep;26(9):1168-e78. doi: 10.1111/ene.13961. Epub 2019 May 9.
• Pan Y, Chen W, Wang Y, Li H, Johnston SC, Simon T, Zhao X, Liu L, Wang D, Meng X, Wang Y; Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) Investigators. Association Between ABCB1 Polymorphisms and Outcomes of Clopidogrel Treatment in Patients With Minor Stroke or Transient Ischemic Attack: Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol. 2019 May 1;76(5):552-560. doi: 10.1001/jamaneurol.2018.4775.
• Wang G, Jing J, Pan Y, Meng X, Zhao X, Liu L, Li H, Wang D, Wang Y, Wang Y; CHANCE Investigatores. Does all single infarction have lower risk of stroke recurrence than multiple infarctions in minor stroke? BMC Neurol. 2019 Jan 8;19(1):7. doi: 10.1186/s12883-018-1215-0.
• Wang A, Li S, Zhang N, Dai L, Zuo Y, Wang Y, Meng X, Wang Y. Oxidized Low-Density Lipoprotein to High-Density Lipoprotein Ratio Predicts Recurrent Stroke in Minor Stroke or Transient Ischemic Attack. Stroke. 2018 Nov;49(11):2637-2642. doi: 10.1161/STROKEAHA.118.022077.
• Zhu B, Liu H, Pan Y, Jing J, Li H, Zhao X, Liu L, Wang D, Johnston SC, Wang Z, Wang Y, Wang Y; CHANCE Investigators. Elevated Neutrophil and Presence of Intracranial Artery Stenosis Increase the Risk of Recurrent Stroke. Stroke. 2018 Oct;49(10):2294-2300. doi: 10.1161/STROKEAHA.118.022126.
• Wang A, Xu J, Chen G, Wang D, Johnston SC, Meng X, Lin J, Li H, Cao Y, Zhang N, Ma C, Dai L, Zhao X, Liu L, Wang Y, Wang Y. Oxidized low-density lipoprotein predicts recurrent stroke in patients with minor stroke or TIA. Neurology. 2018 Sep 4;91(10):e947-e955. doi: 10.1212/WNL.0000000000006118. Epub 2018 Aug 8.
• Ma Y, Liu Y, Xu J, Wang Y, Wang Y, Du F. Effect of dual antiplatelet on recurrent stroke in minor stroke or TIA depends on bodyweight. Ther Clin Risk Manag. 2018 May 8;14:861-870. doi: 10.2147/TCRM.S156694. eCollection 2018.
• Wangqin R, Wang X, Wang Y, Xian Y, Zhao X, Liu L, Li H, Meng X, Wang Y. Risk factors associated with 90-day recurrent stroke in patients on dual antiplatelet therapy for minor stroke or high-risk TIA: a subgroup analysis of the CHANCE trial. Stroke Vasc Neurol. 2017 Jul 6;2(4):176-183. doi: 10.1136/svn-2017-000088. eCollection 2017 Dec.
• Pan Y, Cai X, Jing J, Meng X, Li H, Wang Y, Zhao X, Liu L, Wang D, Johnston SC, Wei T, Wang Y; CHANCE Investigators. Stress Hyperglycemia and Prognosis of Minor Ischemic Stroke and Transient Ischemic Attack: The CHANCE Study (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events). Stroke. 2017 Nov;48(11):3006-3011. doi: 10.1161/STROKEAHA.117.019081.
• Wang D, Gui L, Dong Y, Li H, Li S, Zheng H, Wang A, Meng X, Liu LP, Wang YL, Wang G, Jing J, Li Z, Zhao XQ, Wang YJ. Dual antiplatelet therapy may increase the risk of non-intracranial haemorrhage in patients with minor strokes: a subgroup analysis of the CHANCE trial. Stroke Vasc Neurol. 2016 Jun 24;1(2):29-36. doi: 10.1136/svn-2016-000008. eCollection 2016 Jun.
• Lin Y, Wang A, Li J, Lin J, Wang D, Meng X, Ou L, Chen W, Zhao X, Liu L, Wang Y, Wang Y; CHANCE Investigators. Impact of Glycemic Control on Efficacy of Clopidogrel in Transient Ischemic Attack or Minor Stroke Patients With CYP2C19 Genetic Variants. Stroke. 2017 Apr;48(4):998-1004. doi: 10.1161/STROKEAHA.116.016463. Epub 2017 Mar 13.
• Zhou Y, Pan Y, Wu Y, Zhao X, Li H, Wang D, Johnston SC, Liu L, Wang C, Meng X, Wang Y, Wang Y; CHANCE Investigators. Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack: CHANCE Substudy (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events). Stroke. 2016 Nov;47(11):2791-2796. doi: 10.1161/STROKEAHA.116.014761. Epub 2016 Oct 13.
• Pan Y, Jing J, Li H, Wang Y, Wang Y, He Y; CHANCE investigators. Abnormal glucose regulation increases stroke risk in minor ischemic stroke or TIA. Neurology. 2016 Oct 11;87(15):1551-1556. doi: 10.1212/WNL.0000000000003200. Epub 2016 Sep 9.
• Li J, Zhao X, Meng X, Lin J, Liu L, Wang C, Wang A, Wang Y, Wang Y; CHANCE Investigators. High-Sensitive C-Reactive Protein Predicts Recurrent Stroke and Poor Functional Outcome: Subanalysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events Trial. Stroke. 2016 Aug;47(8):2025-30. doi: 10.1161/STROKEAHA.116.012901. Epub 2016 Jun 21.
• Li Z, Wang Y, Zhao X, Liu L, Wang D, Wang C, Meng X, Li H, Pan Y, Wang X, Wang C, Yang X, Zhang C, Jing J, Xian Y, Johnston SC, Wang Y; CHANCE Investigators. Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack. J Am Heart Assoc. 2016 Mar 21;5(3):e003038. doi: 10.1161/JAHA.115.003038.
• Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y; CHANCE Investigators. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015 Sep 29;85(13):1154-62. doi: 10.1212/WNL.0000000000001972.
• Li J, Wang Y, Lin J, Wang D, Wang A, Zhao X, Liu L, Wang C, Wang Y; CHANCE Investigators. Soluble CD40L Is a Useful Marker to Predict Future Strokes in Patients With Minor Stroke and Transient Ischemic Attack. Stroke. 2015 Jul;46(7):1990-2. doi: 10.1161/STROKEAHA.115.008685. Epub 2015 May 26.
• Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston SC, Liu L, Meng X, Wang A, Wang C, Wang Y; CHANCE Investigators. Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year Outcomes. Circulation. 2015 Jul 7;132(1):40-6. doi: 10.1161/CIRCULATIONAHA.114.014791. Epub 2015 May 8.

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