Stroke studies from China shape global guidance

A landmark programme of stroke research published in The BMJ, Stroke and Vascular Neurology, and The New England Journal of Medicine helped establish new approaches to preventing recurrent stroke after minor stroke and transient ischaemic attack (TIA). Analysis from BMJ Impact Analytics demonstrated the extent to which the wider *clopidogrel in high-risk patients with acute non-disabling cerebrovascular events (CHANCE) research programme had informed clinical guidance and health policy worldwide.

Stroke affects around 15 million people worldwide each year and, according to the World Health Organization, remains one of the leading causes of death and long term disability. In the CHANCE papers, the authors argue that effective prevention strategies are a global clinical priority. People who experience a minor stroke or TIA face a heightened risk of a subsequent stroke, making timely and effective secondary prevention critical.

The CHANCE programme of clinical trials, led by the Chinese Stroke Association, generated important evidence on how that risk could be reduced. The studies showed that short term dual antiplatelet therapy reduced recurrent stroke risk and later demonstrated how genetic testing could guide more personalised treatment.

The CHANCE programme gave clinicians stronger evidence on when to use short-term dual antiplatelet therapy after minor stroke or TIA, and how genetic testing could support more personalised treatment. BMJ Impact Analytics enabled the researchers to demonstrate how these findings had informed clinical guidance and policy across 62 countries, providing a broader picture than academic citation counts alone.

Impact at a glance *

57 citations in clinical guidelines and health policy documents from CHANCE-related papers collectively
14 years year of CHANCE research (2009–2023)
5,000+ patients enrolled at 114 centres in China in the original CHANCE trial
62 countries citing Chinese stroke research in policy and guidance documents
Research was cited by National Institute of Clinical Excellence (NICE), the World Health Organization, the American Academy of Neurology, and the European Stroke Organisation

“The CHANCE programme has made an important contribution to our understanding of how best to prevent recurrent stroke after minor stroke or TIA. Its influence on clinical guidance internationally demonstrates the value of rigorous clinical research, especially large randomised controlled trials, in informing and improving patient care around the world.”

Philip Bath, Professor of stroke medicine and CHANCE trials investigator, University of Nottingham, UK

“The CHANCE programme has helped strengthen the evidence for preventing recurrent stroke after minor stroke or high risk TIA. Seeing this research reflected in clinical guidelines internationally shows how evidence from major clinical trials can ultimately influence care for patients around the world.”

David Wang, deputy editor and general manager, Stroke and Vascular Neurology, and director of vascular neurology, HonorHealth/Arizona State University John Shufeldt School of Medicine and Medical Engineering, Scottsdale, USA

2019 — The BMJ
Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack

2021 — Stroke and Vascular Neurology
CHANCE-2: rationale and design of a multicentre randomised trial

2024 — The BMJ
Colchicine in patients with acute ischaemic stroke or transient ischaemic attack (CHANCE-3)