Family History is Related to High Risk of Recurrent Events after Ischemic Stroke or Transient Ischemic Attack

Background: In patients with acute minor ischemic stroke or high-risk transient ischemic attack enrolled in the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke [POINT] Trial), the combination of clopidogrel and aspirin for 90 days reduced major ischemic events but increased major hemorrhage in comparison to aspirin alone. Methods: In a secondary analysis of POINT (N=4881), we assessed the time course for benefit and risk from the combination of clopidogrel and aspirin. The primary efficacy outcome was a composite of ischemic stroke, myocardial infarction, or ischemic vascular death. The primary safety outcome was major hemorrhage. Risks and benefits were estimated for delayed times of treatment initiation using left-truncated models. Results: Through 90 days, the rate of major ischemic events was initially high then decreased markedly, whereas the rate of major hemorrhage remained low but relatively constant throughout. With the use of a model-based approach, the optimal change point for major ischemic events was 21 days (0–21 days hazard ratio 0.65 for clopidogrel-aspirin versus aspirin; 95% CI, 0.50–0.85; P =0.0015, in comparison to 22–90 days hazard ratio, 1.38; 95% CI, 0.81–2.35; P =0.24). Models showed benefits of clopidogrel-aspirin for treatment delayed as long as 3 days after symptom onset. Conclusions: The benefit of clopidogrel-aspirin occurs predominantly within the first 21 days, and outweighs the low, but ongoing risk of major hemorrhage. When considered with the results of the CHANCE trial (Clopidogrel in High-Risk Patients With Non-disabling Cerebrovascular Events), a similar trial treating with clopidogrel-aspirin for 21 days and showing no increase in major hemorrhage, these results suggest that limiting clopidogrel-aspirin use to 21 days may maximize benefit and reduce risk after high-risk transient ischemic attack or minor ischemic stroke. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00991029.

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Aspirin and clopidogrel compared with clopidogrel alone after recent ischemic stroke or transient ischemic attack in high-risk patients (MATCH): Randomized, double-blind, placebo-controlled trial

ACC Current Journal Review ◽

10.1016/j.accreview.2004.08.105 ◽

2004 ◽

Vol 13 (10) ◽

pp. 17

Author(s):

H.C. Diener ◽

J. Bogousslavsky ◽

L.M. Brass

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Controlled Trial ◽

Double Blind ◽

Double Blind Placebo ◽

High Risk Patients ◽

Risk Patients ◽

Ischemic Attack

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Validation of the ABCD 2 Score to Identify the Patients With High Risk of Late Stroke After a Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽

10.1161/strokeaha.110.578757 ◽

2010 ◽

Vol 41 (6) ◽

pp. 1298-1300 ◽

Cited By ~ 18

Author(s):

Jie Yang ◽

Jian-Hui Fu ◽

Xiang-Yan Chen ◽

Yang-Kun Chen ◽

Thomas W. Leung ◽

...

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Ischemic Attack

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Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients

Blood ◽

10.1182/blood-2020-133476 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 3-3

Author(s):

Omar Raslan ◽

Christopher Tran ◽

Fatimah Al-Ani ◽

Luciano Sposato ◽

Alejandro Lazo-Langner

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Research Funding ◽

Transient Ischemic Attacks ◽

Foramen Ovale ◽

Stroke Patients ◽

Thrombophilia Screening ◽

Ischemic Attack

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits. Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale. Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale. Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits. Disclosures Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.

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Carotid Stenosis and Recurrent Ischemic Stroke

Stroke ◽

10.1161/strokeaha.121.034089 ◽

2021 ◽

Author(s):

Shadi Yaghi ◽

Adam de Havenon ◽

Sara Rostanski ◽

Alexandra Kvernland ◽

Brian Mac Grory ◽

...

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Carotid Stenosis ◽

Transient Ischemic Attack ◽

Stroke Risk ◽

Hazard Ratio ◽

Minor Ischemic Stroke ◽

Increased Risk ◽

Ischemic Stroke Risk ◽

Ischemic Attack

Background and Purpose: Randomized trials demonstrated the benefit of dual antiplatelet therapy in patients with minor ischemic stroke or high-risk transient ischemic attack. We sought to determine whether the presence of carotid stenosis was associated with increased risk of ischemic stroke and whether the addition of clopidogrel to aspirin was associated with more benefit in patients with versus without carotid stenosis. Methods: This is a post-hoc analysis of the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) that randomized patients with minor ischemic stroke or high-risk transient ischemic attack within 12 hours from last known normal to receive either clopidogrel plus aspirin or aspirin alone. The primary predictor was the presence of ≥50% stenosis in either cervical internal carotid artery. The primary outcome was ischemic stroke. We built Cox regression models to determine the association between carotid stenosis and ischemic stroke and whether the effect of clopidogrel was modified by ≥50% carotid stenosis. Results: Among 4881 patients enrolled POINT, 3941 patients met the inclusion criteria. In adjusted models, ≥50% carotid stenosis was associated with ischemic stroke risk (hazard ratio, 2.45 [95% CI, 1.68–3.57], P <0.001). The effect of clopidogrel (versus placebo) on ischemic stroke risk was not significantly different in patients with <50% carotid stenosis (adjusted hazard ratio, 0.68 [95% CI, 0.50–0.93], P =0.014) versus those with ≥50% carotid stenosis (adjusted hazard ratio, 0.88 [95% CI, 0.45–1.72], P =0.703), P value for interaction=0.573. Conclusions: The presence of carotid stenosis was associated with increased risk of ischemic stroke during follow-up. The effect of added clopidogrel was not significantly different in patients with versus without carotid stenosis. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03354429.

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Liraglutide in Acute Minor Ischemic Stroke or High-risk Transient Ischemic Attack Patients With Type 2 Diabetes Mellitus

Case Medical Research ◽

10.31525/ct1-nct03948347 ◽

2019 ◽

Author(s):

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Ischemic Attack

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Stress-Strain Profile of Carotid Plaque With and Without Juxtaluminal Hemorrhage/Thrombus: A Possible Mechanism for Subsequent Cerebrovascular Events

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53078 ◽

2011 ◽

Author(s):

Zhongzhao Teng ◽

Umar Sadat ◽

Jonathan H. Gillard

Keyword(s):

High Risk ◽

Transient Ischemic Attack ◽

Carotid Plaque ◽

Recurrent Events ◽

Atherosclerotic Plaques ◽

High Grade ◽

Benefit Ratio ◽

Clear Cut ◽

Cerebrovascular Events ◽

Ischemic Attack

Patients suffering from a transient ischemic attack (TIA) are at high risk of a stroke or recurrent TIA, with about half of all recurrent events during the seven days after a TIA occurring in the first 24 hours. These events are usually caused by thromboembolization from ruptured carotid atherosclerotic plaques. Large trials have shown that carotid endarterectomy benefits patients with high grade carotid stenosis, but the risk-to-benefit ratio was less clear-cut for symptomatic patients with moderate stenosis (50–69%). Therefore, identification of high-risk plaques within this group could significantly decrease the ratio.

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