Effect of Clopidogrel by Smoking Status on Secondary Stroke Prevention
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Smoking is an established risk factor for stroke and has been linked to poor functional outcomes after acute ischemic stroke. Recently, a smoking−clopidogrel paradox among patients with symptomatic coronary artery disease was observed: smokers treated with clopidogrel had a lower occurrence of myocardial infarction compared with nonsmokers.1 It has been postulated that cigarette smoking could influence the antiplatelet effect of clopidogrel by influencing the activity of cytochrome P450 1A2.2 However, whether clopidogrel has a differential effect by smoking status among stroke patients is unknown. The objective of this study was to assess whether clopidogrel has a differential effect on secondary stroke prevention by smoking status.
We analyzed the data from the CHANCE trial (Clopidogrel in High-Risk Patients with Acute Non-Disabling Cerebrovascular Events).3 The CHANCE protocol was approved by the ethics committee at each study center. All participants or their legal proxies …