Dual antiplatelet therapy in acute ischaemic stroke with or without cerebral microbleeds

Wang, Meng; Yang, Yuyuan; Wang, Yajuan; Luan, Moxin; Xu, Lulu; Zhong, Meixiang; Zheng, Xueping

doi:10.1111/ejn.15938

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Third, the participants of this study were middle-aged and elderly people, it was reported that the prevalence of CMBs increased along with age, 16 and advanced age was independently associated with poor prognosis in patients with stroke. 4,6 However, we could not further analyze the groups of different age levels.…”

Section: Discussionmentioning

confidence: 99%

“…5 In non-cardiogenic ischemic stroke patients treated with antiplatelet therapy, CMBs ≥ 10 pronouncedly increased the risk of recurrent stroke. 6 In anterior circulation acute ischemic stroke patients treated by endovascular thrombectomy, there was no significant association between the presence of CMBs and the risk of ICH. 7 However, little was known on the relationship between CMBs and the clinic outcomes of posterior circulation stroke.…”

mentioning

confidence: 94%

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Association of Cerebral Microbleeds and Risk of Stroke and Mortality in Posterior Circulation Cerebral Infarction

Wang,

Sun,

et al. 2024

Preprint

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Objective This study was investigated to determine whether CMBs were associated with the risk of recurrent stroke or all-cause death in patients with acute posterior circulation cerebral infarction. Methods A retrospective analysis was conducted on 323 patients with acute posterior circulation cerebral infarction who aged ≥ 45 years and were hospitalized at Qingdao University Affiliated Hospital from January 1, 2016 to December 31, 2020. Patients were divided into different CMBs groups according to the presence, number and distribution of CMBs. Occurrence of stroke and death was recorded during follow-up. We drew Kaplan Meier survival curves and constructed Cox proportional hazards regression models based on different CMBs groups and clinical outcomes. Results A total of 323 patients were enrolled in our study, and 138 (42.72%) had CMBs. During a median follow-up of 1357 days, 87 (26.94%) experienced recurrent stroke or death. ≥5 CMBs (HR 1.723; 95% CI 1.021-2.907; P=0.041) and lobar CMBs (HR 2.312; 95% CI 1.204-4.441; P=0.012) were independent predictors associated with the composite risk of recurrent stroke and all-cause death. All CMBs statuses were not significantly correlated with the risk of recurrent stroke. The presence of CMBs (HR 3.358; 95% CI 1.259-8.954; P=0.015), ≥ 5 CMBs (HR 5.290; 95% CI 1.599-17.499; P=0.006) and deep CMBs (HR 3.265; 95% CI 1.003-10.628; P=0.049) were all independent factors associated with all-cause death. Conclusions In patients with acute posterior circulation cerebral infarction, ≥5 CMBs and lobar CMBs may increase the risk of poor clinical outcome (the composite of recurrent stroke and all-cause death). Furthermore, the presence CMBs, ≥ 5 CMBs and deep CMBs all independently may increase the risk of all-cause death.

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Section: Discussionmentioning

confidence: 99%

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confidence: 94%

Association of Cerebral Microbleeds and Risk of Stroke and Mortality in Posterior Circulation Cerebral Infarction

Wang,

Sun,

et al. 2024

Preprint

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Effects of dual antiplatelet therapy (DAPT) compared to single antiplatelet therapy (SAPT) in patients with traumatic brain injury

Sashida,

Suehiro,

Tanaka

et al. 2024

Clinical Neurology and Neurosurgery

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Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack

De Matteis,

Ornello,

De Santis

et al. 2024

European Stroke Journal

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Background and purpose: Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs. Methods: READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD2 score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment. Results: We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding. Conclusions: In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.

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Dual antiplatelet therapy in acute ischaemic stroke with or without cerebral microbleeds

Cited by 3 publications

References 21 publications

Association of Cerebral Microbleeds and Risk of Stroke and Mortality in Posterior Circulation Cerebral Infarction

Association of Cerebral Microbleeds and Risk of Stroke and Mortality in Posterior Circulation Cerebral Infarction

Effects of dual antiplatelet therapy (DAPT) compared to single antiplatelet therapy (SAPT) in patients with traumatic brain injury

Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack

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