High Prevalence of Previous Antiplatelet Drug Use in Patients with New or Recurrent Ischemic Stroke: Buffalo Metropolitan Area and Erie County Stroke Study

Qureshi, Adnan I.; Kirmani, Jawad F.; Safdar, Adnan; Ahmed, S. Sultan; Sayed, Muhammad A.; Pande, Ravi U.; Ferguson, R. Matthew; Hershey, Linda A.; Qazi, Khalid J.

doi:10.1592/phco.26.4.493

Cited by 13 publications

(11 citation statements)

References 19 publications

(18 reference statements)

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“…Also, such patients are known to have more cerebrovascular risk factors. 29 Similarly to previous studies, we observed an independent association between stroke mechanism and recurrence risk. 9,30 Most closely related to recurrence was the category of other determined cause (mostly rare causes), indicating that underlying systemic disease such as cancer, endocarditis or vasculitis may lead to an inherently high recurrence rate or are non-responsive to current treatment strategies.…”

Section: Discussionsupporting

confidence: 90%

A score to predict one-year risk of recurrence after acute ischemic stroke

Strambo

Zachariadis

Lambrou

et al. 2020

International Journal of Stroke

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Background An acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke. Methods An integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens ( n = 2495), Milan ( n = 1279), and Helsinki ( n = 714) by means of calibration and discrimination. Results In the derivation cohort, the recurrence rate was 7% ( n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9–4.1) in 932 (29%) patients with a score 0–1, 7.2% (6.1–8.3) in 2038 (63%) with a score 2–4, and 19.2% (14.6–23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively. Conclusion We developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors.

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Section: Discussionsupporting

confidence: 90%

A score to predict one-year risk of recurrence after acute ischemic stroke

Strambo

Zachariadis

Lambrou

et al. 2020

International Journal of Stroke

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“…20 Qureshi et al reported a high proportion of patients who developed ischemic stroke despite receiving antiplatelet drugs, in their regional hospital-based study. 21 CAST and the similarly large International Stroke Trial (IST) showed reliably that aspirin started early in hospital produces a small but definite net benefit, with approximately 9±3 fewer deaths or non-total strokes per 1,000 in the first few weeks and with 13±5 fewer dead or dependent per 1,000 after some weeks or months of followup. 7 As an observational perspective study, the current largest stroke registry program in China revealed the benefit of long-term antiplatelet therapy after ischemic stroke, which is consistent with that demonstrated in other populations.…”

Section: Discussionmentioning

confidence: 99%

Association of Antiplatelet Therapy With Lower Risk of Death and Recurrent Cerebrovascular Events After Ischemic Stroke

Ding¹,

Lü²,

Fu³

et al. 2009

Circ J

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“…Meta-analyses of randomized clinical trials indicate that the combination of aspirin plus dipyridamole is the preferred antiplatelet regimen, reducing the risk of recurrent vascular events to 34% among patients with TIA and ischemic stroke of arterial origin [24] . However, in a regional hospital-based study, Qureshi et al [25] reported a higher proportion of patients who developed ischemic stroke despite taking antiplatelet drugs. Observational prospective studies in China, the current study, and the Nanjing Stroke Registry Program came to the conclusion that antiplatelet therapy was associated with decreased risk of the occurrence of a further vascular event after acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 98%

Predictors of Vascular Events after Ischemic Stroke: The China Ischemic Stroke Registry Study

Ding

Lü²,

Fu³

et al. 2009

Neuroepidemiology

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Background/Aims: To measure the risk of vascular event occurrence among postischemic stroke patients in mainland China. Methods: In this multicenter prospective stroke registry study, we enrolled 1,951 patients diagnosed with acute ischemic stroke. Demographic data, prestroke risk factors, severity of neurological deficits and disability graded on the National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale scores of each patient were measured and recorded. Patients were followed up regularly for 12 months after recruitment. Clinical endpoints were defined as occurrence of vascular events or death. Results: We detected 103 cases with nonfatal vascular events and 27 cases that died of vascular events. Cumulative incidences of total vascular events, cerebrovascular events, and coronary artery diseases were 7.2, 5.0, and 1.8%, respectively, at 12 months after the initial ischemic stroke. Concomitant atherosclerotic-thrombotic diseases (HR, 1.68; 95% CI, 1.14–2.43) and baseline NIHSS (HR, 1.07; 95% CI, 1.03–1.11) were found to be the best predictors for further occurrence of a vascular event. Antiplatelet therapy (HR, 0.52; 95% CI, 0.35–0.77) is associated with a lower risk of further vascular events. Conclusion: Our study provided valuable data on prognosis of acute ischemic stroke in Chinese patients.

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High Prevalence of Previous Antiplatelet Drug Use in Patients with New or Recurrent Ischemic Stroke: Buffalo Metropolitan Area and Erie County Stroke Study

Abstract: The relatively high proportion of patients who developed ischemic stroke despite taking antiplatelet drugs observed in this regional hospital-based study mandates clinical trials specifically addressing therapeutic intervention for this group of patients.

Cited by 13 publications

References 19 publications

A score to predict one-year risk of recurrence after acute ischemic stroke

A score to predict one-year risk of recurrence after acute ischemic stroke

Association of Antiplatelet Therapy With Lower Risk of Death and Recurrent Cerebrovascular Events After Ischemic Stroke

Predictors of Vascular Events after Ischemic Stroke: The China Ischemic Stroke Registry Study

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