Dual Antiplatelet Therapy in Patients With Metabolic Syndrome After Mild Ischemic Stroke or Transient Ischemic Attack
Bibliographic record
Abstract
Background Metabolic syndrome (MetS) attenuates antiplatelet agent effects. This study investigated the efficacy and safety of clopidogrel–aspirin therapy for secondary stroke prevention in patients with MetS. Methods Data were obtained from the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High‐Risk Intracranial or Extracranial Atherosclerosis) trial. Patients with mild ischemic stroke or high‐risk transient ischemic attack were randomized to treatment with clopidogrel–aspirin or aspirin alone within 72 hours after symptom onset. MetS was defined according to the Adult Treatment Panel‐III. The primary efficacy outcome was new stroke, and the primary safety outcome was moderate ‐ to ‐ severe bleeding within 90‐day follow‐up. Differences between groups were estimated with Cox proportional hazards models, with hazard ratio (HR) and 95% CI presented. Results This study included 4715 patients, with a mean age of 63.7±9.6 years, 35.8% of women, and 75.8% of patients having MetS. After adjustment for potential confounders, patients with MetS were at higher risk of recurrent stroke (HR, 1.39 [95% CI, 1.06–1.82]; P =0.02) but not moderate ‐ to ‐ severe bleeding events (HR, 1.02 [95% CI, 0.47–2.21]; P =0.97) as compared with patients without MetS. However, MetS state did not impact the efficacy of clopidogrel–aspirin therapy for recurrent stroke ( P for interaction=0.44) and the safety for moderate‐to‐severe bleeding events ( P for interaction=0.54). Conclusions MetS was associated with higher risk of recurrent stroke at 90 days. There was no difference in the effect of clopidogrel–aspirin therapy on reducing new stroke and increasing moderate‐to‐severe bleeding events between patients with and without MetS. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03635749.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".