scholarly journals DNA methylation analyses identify an intronic ZDHHC6 locus associated with time to recurrent stroke in the Vitamin Intervention for Stroke Prevention (VISP) clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254562
Author(s):  
Nicole M. Davis Armstrong ◽  
Wei-Min Chen ◽  
Fang-Chi Hsu ◽  
Michael S. Brewer ◽  
Natalia Cullell ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Dna Methylation ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
University Hospital ◽  
Stroke Recurrence ◽  
Primary Analysis ◽  
Vascular Events ◽  
Network Analyses ◽  
Epigenetic Biomarkers

Aberrant DNA methylation profiles have been implicated in numerous cardiovascular diseases; however, few studies have investigated how these epigenetic modifications contribute to stroke recurrence. The aim of this study was to identify methylation loci associated with the time to recurrent cerebro- and cardiovascular events in individuals of European and African descent. DNA methylation profiles were generated for 180 individuals from the Vitamin Intervention for Stroke Prevention clinical trial using Illumina HumanMethylation 450K BeadChip microarrays, resulting in beta values for 470,871 autosomal CpG sites. Ethnicity-stratified survival analyses were performed using Cox Proportional Hazards regression models for associations between each methylation locus and the time to recurrent stroke or composite vascular event. Results were validated in the Vall d’Hebron University Hospital cohort from Barcelona, Spain. Network analyses of the methylation loci were generated using weighted gene coexpression network analysis. Primary analysis identified four significant loci, cg04059318, ch.2.81927627R, cg03584380, and cg24875416, associated with time to recurrent stroke. Secondary analysis identified three loci, cg00076998, cg16758041, and cg02365967, associated with time to composite vascular endpoint. Locus cg03584380, which is located in an intron of ZDHHC6, was replicated in the Vall d’Hebron University Hospital cohort. The results from this study implicate the degree of methylation at cg03584380 is associated with the time of recurrence for stroke or composite vascular events across two ethnically diverse groups. Furthermore, modules of loci were associated with clinical traits and blood biomarkers including previous number of strokes, prothrombin fragments 1 + 2, thrombomodulin, thrombin-antithrombin complex, triglyceride levels, and tissue plasminogen activator. Ultimately, these loci could serve as potential epigenetic biomarkers that could identify at-risk individuals in recurrence-prone populations.

scholarly journals Multi-omic analysis of stroke recurrence in African Americans from the Vitamin Intervention for Stroke Prevention (VISP) clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247257
Author(s):  
Nicole M. Davis Armstrong ◽  
Kelsey J. Spragley ◽  
Wei-Min Chen ◽  
Fang-Chi Hsu ◽  
Michael S. Brewer ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Dna Methylation ◽  
African Americans ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
European Ancestry ◽  
Sphingolipid Metabolism ◽  
Stroke Recurrence ◽  
High Risk Population ◽  
Vascular Events

African Americans endure a nearly two-fold greater risk of suffering a stroke and are 2–3 times more likely to die from stroke compared to those of European ancestry. African Americans also have a greater risk of recurrent stroke and vascular events, which are deadlier and more disabling than incident stroke. Stroke is a multifactorial disease with both heritable and environmental risk factors. We conducted an integrative, multi-omic study on 922 plasma metabolites, 473,864 DNA methylation loci, and 556 variants from 50 African American participants of the Vitamin Intervention for Stroke Prevention clinical trial to help elucidate biomarkers contributing to recurrent stroke rates in this high risk population. Sixteen metabolites, including cotinine, N-delta-acetylornithine, and sphingomyelin (d17:1/24:1) were identified in t-tests of recurrent stroke outcome or baseline smoking status. Serum tricosanoyl sphingomyelin (d18:1/23:0) levels were significantly associated with recurrent stroke after adjusting for covariates in Cox Proportional Hazards models. Weighted Gene Co-expression Network Analysis identified moderate correlations between sphingolipid markers and clinical traits including days to recurrent stroke. Integrative analyses between genetic variants in sphingolipid pathway genes identified 29 nominal associations with metabolite levels in a one-way analysis of variance, while epigenomic analyses identified xenobiotics, predominately smoking-associated metabolites and pharmaceutical drugs, associated with methylation profiles. Taken together, our results suggest that metabolites, specifically those associated with sphingolipid metabolism, are potential plasma biomarkers for stroke recurrence in African Americans. Furthermore, genetic variation and DNA methylation may play a role in the regulation of these metabolites.

scholarly journals Intracranial Vertebrobasilar Calcification in Patients with Ischemic Stroke Is a Predictor of Recurrent Stroke, Vascular Disease, and Death: A Case-Control Study

2020 ◽  
Vol 17 (6) ◽  
pp. 2013
Author(s):  
Jožef Magdič ◽  
Nino Cmor ◽  
Matevž Kaube ◽  
Tanja Hojs Fabjan ◽  
Larissa Hauer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vascular Disease ◽  
Recurrent Stroke ◽  
Case Control ◽  
University Hospital ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Vertebrobasilar Artery ◽  
The Impact

Intracranial artery calcification can be detected on nonenhanced brain computer tomography (NECT) and is a predictor of early vascular events. Here, we assessed the impact of vertebrobasilar artery calcification (VBC) on the long-term risk for recurrent stroke and vascular events. We performed a case-control trial of all consecutive stroke patients admitted to the University Hospital of Maribor, Slovenia over a period of 14 months. VBC was defined as presence of a hyperdense area within vertebrobasilar arteries that exceeds > 90 Hounsfield units as seen on NECT. Clinical follow-up information was obtained from the hospital documentation system and mortality registry of the district and included recurrent stroke, subsequent vascular events (myocardial infarction, heart failure, peripheral arterial occlusive disease), and death. We followed a total of 448 patients for a median of 1505 days (interquartile range, IQR 188-2479). Evidence for VBC was present in 243 (54.2%) patients. Median age was 76 years, recurrent stroke occurred in 33 (7.4%), any vascular events in 71 (15.8%), and death in 276 (61.6%). VBC was associated with a higher risk of recurrent stroke (hazard ratio, HR 3.13, 95% confidence interval (CI 1.35–7.20)) and vascular events (HR 2.05, 95% CI 1.21–3.47). Advanced age, male gender, and ischemic stroke involving the entire anterior circulation raised the likelihood for death. We conclude that the presence of VBC in patients with ischemic stroke is a short- and long-term prognostic factor for stroke recurrence and subsequent manifestation of acute vascular disease. Further understanding of the pathophysiology of VBC is warranted.

Stroke with Transfusions Changing to Hydroxyurea (SWiTCH): A Phase 3 Randomized Clinical Trial for Treatment of Children with Sickle Cell Anemia, Previous Stroke, and Iron Overload

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 844-844 ◽  
Author(s):  
Russell E. Ware ◽  
Ronald W Helms
Keyword(s):  
Clinical Trial ◽  
Iron Overload ◽  
Recurrence Rate ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Study Enrollment

Abstract Abstract 844 Stroke occurs in 5–10% of children with sickle cell anemia (SCA) and has a very high (50-90%) risk of recurrence without therapy. Chronic monthly erythrocyte transfusions are administered to prevent recurrent stroke, but their long term use is limited by incomplete protection and serious side effects, including alloimmunization and iron overload. An alternative to transfusion for secondary stroke prevention in SCA is needed, ideally one that also improves the management of transfusional iron overload. Stroke With Transfusions Changing to Hydroxyurea (SWiTCH) was an NHLBI-sponsored Phase III multicenter randomized controlled clinical trial for children with SCA, stroke, and iron overload (NCT00122980). The primary goal of SWiTCH was to compare 30 months of alternative therapy (hydroxyurea and phlebotomy) with standard therapy (transfusions and chelation) for the prevention of secondary stroke and reduction of transfusional iron overload. SWiTCH had several distinctive study features with novel methodological and design components, including a composite primary endpoint containing both stroke recurrence rate and iron burden, a transfusion overlap period in the alternative arm to reduce the risk of recurrent stroke until a stable hydroxyurea dose was reached, and an inclusive independent stroke adjudication process for all suspected new neurological events. An increased number of recurrent stroke events were predicted to occur in the alternative arm compared to the standard arm, but this risk would be balanced by improved management of transfusional iron burden by repeated phlebotomy. A total of 161 pediatric subjects (83 male, 78 female) with SCA, documented stroke, and iron overload were enrolled in SWiTCH between October 2006 and April 2009; after screening 133 were randomized and received study treatment (67 participants in the alternative arm, 66 in the standard arm). The average age at enrollment was 12.9 ± 4.0 years with an average of 7.0 ± 3.7 years of chronic transfusions for secondary stroke prevention; 12% had already suffered a recurrent stroke before study enrollment. The average baseline liver iron concentration (LIC) by biopsy was 15.5 ± 10.1 mg Fe per gm dry weight liver and most subjects were receiving oral chelation treatment at the time of study enrollment. At study enrollment, 28% of subjects had previously known RBC alloantibodies (most within the CDE-Kell antigen systems) and 16% had previous RBC autoantibody formation. Baseline laboratory and clinical parameters were well-balanced between treatment arms, although a higher number of subjects with moya-moya were randomized to hydroxyurea/phlebotomy. A scheduled interim data analysis was performed after 1/3 of the subjects had completed all exit studies. This analysis (which occurred with ∼80% of all patient-years of study treatment completed) concluded that the LIC was not statistically different between the two treatment arms so no increased stroke risk was justified. Accordingly, following review by the Data and Safety Monitoring Board, the NHLBI terminated the SWiTCH trial in May 2010; at that time, the on-study stroke recurrence rate was 7 of 67 participants in the alternative arm compared to 0 of 66 participants in the standard arm. At the completion of all study treatment, the recurrent stroke events remained at 7 versus 0 (alternative versus standard arm), while TIA events occurred in 6 and 9 subjects respectively, and deaths were equivalent (1 and 1, both unrelated to treatment). SWiTCH primary and secondary endpoint analyses are currently in progress and details of the study results will be presented. Disclosures: Off Label Use: Hydroxyurea is used to reduce complications of sickle cell anemia.

scholarly journals Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) study protocol

2019 ◽  
Vol 15 (1) ◽  
pp. 109-115
Author(s):  
Mahesh Pundlik Kate ◽  
Deepti Arora ◽  
Shweta Jain Verma ◽  
PN Sylaja ◽  
Vishnu Renjith ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Acute Stroke ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Standard Of Care ◽  
Clinical Trial Registry ◽  
Cardiovascular Morbidity And Mortality ◽  
Recurrent Strokes

Rationale Recurrent stroke, cardiovascular morbidity, and mortality are important causes of poor outcome in patients with index stroke. Despite the availability of best medical management recurrent stroke occur in up to 15–20% of patients with stroke in India. Education for stroke prevention could be a strategy to prevent recurrent strokes. Hypothesis We hypothesize that a structured semi-interactive stroke prevention package can reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke at the end of one year. Design Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA (SPRINT INDIA) is a multi-center stroke trial involving 25 centers under the Indian Stroke Clinical Trial Network. Patients with first ever sub-acute stroke within two days to three months of onset, age 18–85 years, mRS <5, showing recent stroke in imaging are included. Participants or caregivers able to read and complete tasks suggested in a stroke prevention workbook and have a cellular device for receiving short message service and watching videos. A total of 5830 stroke patients speaking 11 different languages are being randomized to intervention or control arm. Patients in the intervention arm are receiving a stroke prevention workbook, regular educational short messages, and videos. All patients in the control arm are receiving standard of care management. Summary Structured semi-interactive stroke prevention package may reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke. Trial registration This trial is registered with clinicaltrials.gov (NCT03228979) and CTRI (Clinical Trial Registry India; CTRI/2017/09/009600).

scholarly journals Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

2021 ◽  
Vol 23 (1) ◽  
pp. 51-60
Author(s):  
Yuesong Pan ◽  
Zixiao Li ◽  
Jiejie Li ◽  
Aoming Jin ◽  
Jinxi Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Antihypertensive Agents ◽  
Residual Risk ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Abstract TP419: Medication Adherence as a Modulator of Ischemic Stroke Recurrence in the Veteran Population - The MISTER-VA Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sakshi Luthra ◽  
Alexander Crossley ◽  
Pooja B Butani ◽  
Hyojin C Suh ◽  
Melisa Kamali-Grigorian ◽  
...  
Keyword(s):  
Relative Risk ◽  
Medication Adherence ◽  
Median Time ◽  
Stroke Prevention ◽  
Lower Risk ◽  
Chart Review ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Medication Regimen ◽  
Strict Adherence

Introduction: Recurrent strokes make up 25% of the annual stroke incidence with 10% of the Veteran population suffering a recurrent stroke within 1 year. The role of adherence to a post-stroke medication regimen and its effect on stroke recurrence is unknown. Methods: Veterans evaluated in a vascular neurology specialty clinic from July 2010 to June 2016 underwent a detailed medical chart review and assessment of medication adherence to stroke prevention medications including anti-thrombotic use, anti-coagulants, anti-hypertensives, lipid-lowering therapy, and anti-hyperglycemic therapy. Medication adherence was measured by 90d refill history with >75% medication possession ratio (MPR) indicating adherence. A Framingham Stroke Risk Profile (FSRP) Score was calculated for each patient. Relative risk calculations were generated using a bivariate analysis and means compared via t-test. Results: 162 of 245 patients who were newly referred to the clinic underwent a detailed chart review and medication adherence profile. In this cohort, 93.8% were male and ranged in age between 35-94 years old (mean 69.2±10.2). The mean age of first stroke was 62.9±10.5 and the frequency of recurrent stroke was 26.5% (43 patients). The median time to recurrent stroke was 2.59 years. The average FSRP score for all subjects was 0.087±0.09 and did not differ between those with or without a recurrent stroke (0.103 vs. 0.082, p= 0.18). The rate of medication adherence in all subjects was 69.8% and differed greatly between those without and with a recurrent stroke, 79.0% vs. 44.2%, respectively. Median time to recurrent stroke was 2.59 years in those with MPR >75% and 1.91 years in those with MPR <75%. Strict adherence with a stroke prevention medication regimen was associated with a lower risk of recurrent stroke (relative risk = 0.34, 95% CI 0.21-0.57, p -value <0.0001) while poor adherence, was associated with a 2.91-fold increased risk ( p -value <0.0001) of recurrent stroke in the Veteran population. Conclusion: In this high-risk Veteran population, strict adherence with a stroke prevention medication regimen is associated with a lower risk of recurrent stroke. Efforts to measure and encourage medication adherence in patients with prior stroke may reduce the risk of recurrence.

Abstract TP180: Ankle-brachial Index and Recurrent Stroke Risk: a Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Thomas Liman ◽  
Ja Bin Hong ◽  
Christopher Leonards ◽  
Bob Siegerink ◽  
Matthias Endres
Keyword(s):  
Recurrent Stroke ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Stroke Recurrence ◽  
Significant Heterogeneity ◽  
Vascular Events ◽  
Vascular Death ◽  
Atherosclerotic Burden ◽  
Increased Risk

Background and Purpose: The ankle-brachial index (ABI) is a fast, cheap, non-invasive indicator of atherosclerotic burden that may also be indicative of stroke recurrence. In this systematic review and meta-analysis, we sought to explore ABI’s merit as a marker for stroke recurrence and vascular risk by synthesizing the data currently available in the stroke literature. Methods: We searched Embase, MEDLINE, and Pubmed databases for prospective cohort studies that included consecutive stroke and/or transient ischemic attack (TIA) patients, measured ABI at baseline, and performed a follow-up assessment at least 12 months following initial stroke/TIA. The following endpoints were chosen for our analysis: (1) recurrent stroke and (2) combined vascular endpoint (recurrent vascular event or vascular death). Crude risk ratios and adjusted Cox proportional hazard ratios (HRs) were combined separately using the random-effects model. Study level characteristics (e.g. percent of cohort with a history of hypertension, average cohort age, and mean follow-up duration) were included as meta-regression covariates. Results: We included 11 studies (5374 patients). Low ABI was associated with an increased risk of recurrent stroke (pooled estimated HR 1.70, 95% CI 1.10-2.64) and vascular events or vascular death, following stroke (pooled estimated HR 2.22, 95% CI 1.67-2.97). No significant heterogeneity was observed in the meta-analysis. Conclusion: Our results confirm the prognostic value of ABI for the recurrence of stroke. It is likely that the inclusion of ABI in risk calculation models will help in improving accuracy of existing models.

Abstract 236: Poor Recurrent Stroke Prevention Knowledge in High Risk Stroke Survivors

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Janice V Scobie ◽  
Kezhen Fei ◽  
Rennie Negron ◽  
Stanley Turhim ◽  
Bernadette Boden-Albala ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Baseline Survey ◽  
Stroke Survivors ◽  
Prevention Measures ◽  
Cross Sectional ◽  
Stroke Knowledge

Stroke is highly prevalent. Control of hypertension, hyperlipidemia and appropriate antithrombotic use are important in preventing recurrent stroke. Inadequate control of cardiovascular (CV) risk factors and poor stroke knowledge among transient ischemic attack (TIA) and stroke survivors impact stroke recurrence. We used a community-based participatory approach to recruit TIA/stroke survivors from community and clinical sites into a randomized controlled stroke prevention educational intervention trial. We conducted a cross-sectional analysis of baseline survey responses describing demographics, clinical characteristics, and stroke knowledge. The sample (n=600) had a mean age of 63 and was mostly female (60%), Black or Hispanic (81%), and insured (98%). 72% had 2 or more CV risk factors: hypertension (33%), high low-density lipoprotein levels (43%), obesity (41%), and tobacco use (17%). 47% had 2 or more poorly controlled risk factors, and 65% did not have controlled blood pressure and cholesterol levels and antithrombotic use. Stroke knowledge of effective stroke prevention measures was poor. Most believed that diet (60%), exercise (36%), and stress reduction (36%) were most important for stroke prevention. Despite poor risk factor control and stroke prevention knowledge, 82% had a doctor and 2 or more visits in the past 6 months. Inadequate control of CV risk factors and poor stroke knowledge is widely prevalent among TIA/stroke survivors. A silent high risk for progression of recurrent strokes and CV comorbidities persists despite regular medical care. Interventions that improve knowledge, support behavioral change, and improve patient self-management skills are critical for effective secondary stroke prevention.

Abstract T P393: New Pooled Cohort Risk Equations: Application to a Recent Stroke Patient Population

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jong-Ho Park ◽  
Hyung-Min Kwon ◽  
Bruce Ovbiagele
Keyword(s):  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Continuous Variable ◽  
Atherosclerotic Cardiovascular Disease ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Vascular Events ◽  
Stroke Risk Factors ◽  
Vascular Death ◽  
C Statistic

Background: In 2013, Pooled Cohort Risk (PCR) equations, which incorporates new sex- and race-specific estimates of the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) including stroke, for ASCVD-free adults was introduced. Given the similarity of primary and secondary stroke risk factors, and benefit of a potential tool to readily identify stroke patients at high intermediate-term vascular risk for appropriate treatment, we evaluated the prediction and discrimination of the PCR and Framingham Cardiovascular Risk (FCR) equations after a recent stroke. Method: We conducted an analysis of Vitamin Intervention for Stroke Prevention dataset of 3555 recent ischemic stroke patients aged ≥35 years and followed for 2 years. The PCR and FCR scores were calculated using the coefficients for the equations for calculating an estimate of an individual’s 10-year vascular risk. Subjects were categorized as having low-PCR/-FCR (<20%), high-PCR/-FCR (≥20%), and known-ASCVD. Independent associations of high-PCR/-FCR with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed. Model discrimination (c-statistic) was assessed using the areas under the receiver operating characteristic curves. Results: Both the PCR and FCR were independently related to both outcomes: compared with low-PCR, high-PCR was associated with stroke (adjusted hazard ratio [AHR], 1.79; 95% CI, 1.25–2.57) and stroke/CHD/vascular death (2.05; 1.55–2.70). Compared with low-FCR, high-FCR was associated with stroke (2.06; 1.34–3.16) and stroke/CHD/vascular death (1.57; 1.12–2.20). The c-statistic of PCR/FCR as a continuous variable for stroke was 0.56 (95% CI, 0.54–0.58) and 0.56 (0.54–0.57), respectively and for stroke/CHD/vascular death was 0.62 (0.60–0.63) and 0.61 (0.59–0.63), respectively. Conclusions: Both the PCR and FCR are significant predictors of recurrent vascular events, but neither one of them appear to be an optimal model to discriminate intermediate-term ASCVD prediction among recent stroke patients already receiving secondary stroke prevention.

Selecting an optimal antiplatelet agent for secondary stroke prevention

2020 ◽  
pp. 10.1212/CPJ.0000000000000842
Author(s):  
Karen C. Albright ◽  
Virginia J. Howard ◽  
George Howard
Keyword(s):  
Stroke Prevention ◽  
Extended Release ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Antiplatelet Agent ◽  
Secondary Stroke Prevention ◽  
Vascular Events ◽  
Randomized Controlled ◽  
Participant Selection ◽  
Selection Of

Four seminal randomized controlled trials (RCTs) have investigated aspirin, aspirin plus extended release dipyridamole, and clopidogrel for the prevention of recurrent vascular events. Despite studying over 32,000 stroke patients in these trials, the decision which antiplatelet agent to select for secondary stroke prevention remains controversial. Attempts to translate the results of these RCTs into clinical practice are complicated by each trial’s selection of participants and choice of primary outcome. Herein, we argue that by examining RCT results with participant selection limited to patients with ischemic stroke or TIA and by focusing on recurrent stroke as our outcome, we can use the standard epidemiology two-by-two table to assist in selecting an antiplatelet agent for secondary stroke prevention.

Sign in / Sign up

Export Citation Format

Share Document