The effect of dual antiplatelet therapy in different patterns of watershed infarction: Subgroup analysis of the INSPIRES trial
Year: 2026
Type: article
Abstract: Watershed infarction (WI) is heterogeneous. This study aims to explore the effect of clopidogrel-aspirin in patients with WI and which WI patterns could gain more benefits. Patients are classified into cortical WI (CWI) (n = 484), internal WI (IWI) (n = 372), CWI+IWI (n = 410), and non-WI (n = 4,033) according to diffusion-weighted magnetic resonance imaging. The results show that patients with WI treated with clopidogrel-aspirin have a lower risk of stroke recurrence compared to aspirin at 90 days (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.49-0.93). Specifically, patients receiving clopidogrel-aspirin show a lower rate of recurrent stroke than those receiving aspirin in IWI (HR, 0.54; 95% CI, 0.30-0.97), and with a similar trend in CWI+IWI, but not significant in CWI (p for interaction = 0.41). Clopidogrel-aspirin does not increase moderate-to-severe bleeding across WI patterns. This study reveals that the effect of clopidogrel-aspirin appears consistent across WI subgroups, but it might be more effective in patients with IWI. This study is registered at Clinicaltrials.gov (NCT03635749).
Source: Cell Reports Medicine
Institutions: Capital Medical University, Zhengzhou University, Beijing Tian Tan Hospital, First Affiliated Hospital of Zhengzhou University, University of British Columbia, Medical University of South Carolina, The University of Texas at Austin, Barrow Neurological Institute, Université Paris Cité, Population Health Research Institute, McMaster University, University of Nottingham, Chinese Academy of Medical Sciences & Peking Union Medical College, Chinese Institute for Brain Research
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,620
OpenAlex ID: W7127901747