{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:06:03Z","timestamp":1779793563059,"version":"3.53.1"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">VCAM\u20101 (vascular cellular adhesion molecule\u20101) is an inflammatory biomarker linked to the occurrence and recurrence of stroke. However, it is uncertain if dual antiplatelet treatments may have distinct benefit for patients with varied stroke causes and VCAM\u20101 levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This post hoc study of the CHANCE\u20102 (Ticagrelor or Clopidogrel in High\u2010Risk Patients With Acute Nondisabling Cerebrovascular Events II) trial included 5651 patients in total. All patients were classified using the Causative Classification of Stroke system categorization as well as the mean of baseline VCAM\u20101 level. The primary outcome was any stroke within 90\u2009days. During the 90\u2010day follow\u2010up period, the cumulative incidence of outcomes between 2 dual antiplatelet treatments was compared using the Kaplan\u2013Meier analysis and log\u2010rank test. The Cox proportional hazards model was used to further assess the hazard ratios (HRs) and 95% CIs for the associations of small artery occlusion cause and VCAM\u20101 level with efficiency and safety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The median age of 5651 patients was 64.8\u2009years, 1908 of whom were women. Among all the subtypes, patients with nonelevated VCAM\u20101 (&lt;1715.9 ng\/mL) and small artery occlusion subtype (N=1252) got more benefit from aspirin\u2010ticagrelor therapy to reduce recurrent stroke within 90\u2009days (7.5% versus 2.9%, hazard ratio [HR], 0.37 [95% CI, 0.22\u20130.64],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Regarding safety outcomes, the risk of mild bleeding was increased in the ticagrelor\u2010aspirin group (1.4% versus 6.7%, HR, 4.85 [95% CI, 2.36\u20139.96]), but no significant difference was found between the 2 groups in moderate or severe bleeding (0.6% versus 0.5%, HR, 0.75 [95% CI, 0.17\u20133.35]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      VCAM\u20101 level combined with ischemic stroke cause classification subtypes might predict the effect of ticagrelor\u2010aspirin or clopidogrel\u2010aspirin dual antiplatelet therapy in preventing recurrent stroke within 90\u2009days in patients with minor ischemic stroke or transient ischemic attack carrying\n                      <jats:italic toggle=\"no\">CYP2C19<\/jats:italic>\n                      loss\u2010of\u2010function alleles. Patients with small artery occlusion subtype and nonelevated VCAM\u20101 received more clinical benefit from ticagrelor\u2010aspirin versus clopidogrel\u2010aspirin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique Identifier: NCT04078737.\n                    <\/jats:p>\n                  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