Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Pei, Lulu; Chen, Pei; Fang, Hui; Cao, Yuan; Guo, Yinan; Zhang, Rui; Zhao, Lu; Gao, Yuan; Wu, Jun; Sun, Shilei; Wang, Xiaoying; Lo, Eng H.; Buonanno, Ferdinando S.; Ning, MingMing; Xu, Yuming; Song, Bo

doi:10.1038/s41598-020-75666-6

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…However, the tool is effective at helping prevent stroke because it identifies those at high risk effectively and therefore allows earlier implementation of stroke prevention strategies beyond simply controlling blood pressure and diabetes, including lipid profiling, cardiac monitoring, carotid imaging and considering dual antiplatelets. 78 …”

Section: Discussionmentioning

confidence: 99%

Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death

Mbizvo

Schnier

Simpson

et al. 2022

Brain

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This study aims to develop a risk prediction model for epilepsy-related death in adults. In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009–2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index – the Scottish Epilepsy Deaths Study Score (SEDS Score). Odds ratios (OR) were estimated with 95% confidence intervals (CIs). 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency (A&E) attendance (OR 5.1, 95% CI 3.2–8.3), living in deprived areas (OR 2.5, 95% CI 1.6–4.0), developmental epilepsy (OR 3.1, 95% CI 1.7–5.7), raised Charlson Comorbidity Index (CCI) score (OR 2.5, 95% CI 1.2–5.2), alcohol abuse (OR 4.4, 95% CI 2.2–9.2), absent recent neurology review (OR 3.8, 95% CI 2.4–6.1), and generalised epilepsy (OR 1.9, 95% CI 1.2–3.0). SEDS Score model variables were derived from the first four listed above, with CCI ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points, and recent epilepsy-related A&E attendance given 3 points. Compared to having a SEDS Score of 0, those with a SEDS Score of 1 remained low risk, with OR 1.6 (95% CI 0.5–4.8). Those with a SEDS Score of 2–3 had moderate risk, with OR 2.8 (95% CI 1.3–6.2). Those with a SEDS Score of 4–5 and 6–8 were high risk, with OR 14.4 (95% CI 5.9–35.2) and 24.0 (95% CI 8.1–71.2), respectively. The SEDS Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation.

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Section: Discussionmentioning

confidence: 99%

Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death

Mbizvo

Schnier

Simpson

et al. 2022

Brain

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“…There is a possible increased risk of developing hemorrhagic events with DAPT treatment over a 7 International Journal of Vascular Medicine prolonged period of time. A number of research studies have found that DAPT's use of aspirin and clopidogrel, like a 21day use period, reduces the risk of hemorrhagic transformation [105][106][107][108]. Further research is indicated to analyze the effectiveness of DAPT and its optimal therapy duration in high-risk stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…Pei et al analyzed the effect of DAPT and MAPT on stroke risk in TIA patients through positive diffusion-weighted imaging (DWI) [ 107 ]. Researchers found that TIA patients on MAPT had a higher 90-day stroke risk than patients that used DAPT (23.7% vs. 13.4%, p = 0.029).…”

Section: Use Of Antiplatelets In Ischemic Stroke and Hemorrhagic Transformation: Mono-antiplatelet (Aspirin) Versus Dual-antiplatelet (Asmentioning

confidence: 99%

“…Researchers found that TIA patients on MAPT had a higher 90-day stroke risk than patients that used DAPT (23.7% vs. 13.4%, p = 0.029). Additionally, patients who were positive DWI had a higher 90-day stroke risk in comparison to negative DWI patients ( p < 0.001) [ 107 ]. This study also suggests that early administration of DAPT in TIA patients is associated with a 46% decrease of stroke risk in DWI positive TIA patients [ 107 ].…”

Section: Use Of Antiplatelets In Ischemic Stroke and Hemorrhagic Transformation: Mono-antiplatelet (Aspirin) Versus Dual-antiplatelet (Asmentioning

confidence: 99%

“…Additionally, patients who were positive DWI had a higher 90-day stroke risk in comparison to negative DWI patients ( p < 0.001) [ 107 ]. This study also suggests that early administration of DAPT in TIA patients is associated with a 46% decrease of stroke risk in DWI positive TIA patients [ 107 ].…”

Section: Use Of Antiplatelets In Ischemic Stroke and Hemorrhagic Transformation: Mono-antiplatelet (Aspirin) Versus Dual-antiplatelet (Asmentioning

confidence: 99%

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A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Thomas

Plumber

Venkatapathappa

et al. 2021

International Journal of Vascular Medicine

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Acute ischemic strokes (AIS) and hemorrhagic strokes lead to disabling neuropsychiatric and cognitive deficits. A serious and fatal complication of AIS is the occurrence of hemorrhagic transformation (HT). HT is cerebral bleeding that occurs after an ischemic event in the infarcted areas. This review summarises how specific risk factors such as demographic factors like age, gender, and race/ethnicity, comorbidities including essential hypertension, atrial fibrillation, diabetes mellitus, congestive heart failure, and ischemic heart disease along with predictors like higher NIHSS score, larger infarction size, cardioembolic strokes, systolic blood pressure/pulse pressure variability, higher plasma glucose levels, and higher body temperature during ischemic event, lower low-density lipoprotein and total cholesterol, early ischemic changes on imaging modalities, and some rare causes make an individual more susceptible to developing HT. We also discuss few other risk factors such as the role of blood-brain barrier, increased arterial stiffness, and globulin levels in patients postreperfusion using thrombolysis and mechanical thrombectomy. In addition, we discuss the implications of dual antiplatelet therapy and the length of treatment in reference to the incidence of developing HT. Current research into inflammatory mediators and biomarkers such as Cyclooxygenase-2, matrix metalloproteinases, and soluble ST2 and their potential role as treatment options for HT is also briefly discussed. Finally, this review calls for more research into use of dual antiplatelet and the timing of antiplatelet and anticoagulant use in reference to hemorrhagic transformation.

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Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study

Ornello,

Foschi,

De Santis

et al. 2024

International Journal of Stroke

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Background: According to the literature, about one third of patients with brain ischemic symptoms lasting <24 hours, which are classified as TIAs according to the traditional “time-based” definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke. Methods: This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA – i.e. those with ischemic symptoms lasting <24 hours – who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD2 score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days. Results: We included 517 patients – 324 (62.7%) male – with a median (interquartile range – IQR) age of 74 (IQR 65-81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD2 score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before (p=0.178) and after matching (p=0.518). Conclusions: In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain MRI had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups.

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Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Cited by 6 publications

References 19 publications

Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death

Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death

A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study

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