Subsequent ischemic stroke and tobacco smoking: A secondary analysis of the POINT trial.

Background: The aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and to determine whether smoking modifies the effect of clopidogrel-based DAPT on subsequent stroke risk.
Methods: This was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which had a 90-day follow-up period. We used multivariable Cox regression and subgroup interaction analysis to determine the effect of smoking on the risk of subsequent ischemic stroke and major hemorrhage, respectively.
Results: Data from 4877 participants enrolled in the POINT trial were analyzed. Among these, 1004 were current smokers and 3873 were non-smokers at the time of index event. Smoking was associated with a non-significant trend toward an increased risk of subsequent ischemic stroke during follow up (adjusted HR, 1.31 (95% CI, 0.97-1.78), p  = 0.076). The effect of clopidogrel on ischemic stroke did not differ between non-smokers (HR, 0.74 (95% CI, 0.56-0.98), p  = 0.03) and smokers (HR, 0.63 (95% CI, 0.37-1.05), p  = 0.078), p for interaction = 0.572. Similarly, the effect of clopidogrel on major hemorrhage did not differ between non-smokers (hazard ratio, 1.67 (95% CI, 0.40-7.00), p  = 0.481) and smokers (HR, 2.59 (95% CI, 1.08-6.21), p  = 0.032), p for interaction = 0.613.
Conclusions: In this post-hoc analysis of the POINT trial we found that the effect of clopidogrel on reducing subsequent ischemic stroke as well as risk of major hemorrhage did not depend on smoking status, indicating that smokers benefit to a similar degree from DAPT as non-smokers.
Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. de Havenon is funded by NIH-NINDS, has received investigator initiated clinical research funding from Regeneron, AMGEN, and AMAG pharmaceuticals, has received consultant fees from Integra and Novo Nordisk, has equity in TitinKM and Certus, and receives author fees from UpToDate. Dr. Easton received funding for his role in the POINT trial which was sponsored by NIH/NINDS but received drug and placebo from Sanofi. Dr. Johnston received research support from AstraZeneca. The POINT trial was sponsored by NIH/NINDS but received drug and placebo from Sanofi. Dr. Lang reported previously owning stock in Walmart, Target, and Johnson & Johnson outside the submitted work.
(© European Stroke Organisation 2022.)