Prehospital antiplatelet use and functional status on admission of patients with non-haemorrhagic moyamoya disease: a nationwide retrospective cohort study (J-ASPECT study)

Onozuka, Daisuke; Hagihara, Akihito; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Suzuki, Akifumi; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru; Nishimura, Ataru; Kurogi, Ryota; Sayama, Tetsuro; Iihara, Koji

doi:10.1136/bmjopen-2015-009942

Cited by 36 publications

(30 citation statements)

References 55 publications

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“… 7 The DPC database includes data about all patients admitted to participating hospitals, including each patient's profile (e.g., age, sex); principal diagnoses and comorbidities at admission (both coded by the International Classification of Diseases and Injuries, 10th revision); complications after admission (coded similarly); procedures including surgeries, medications, and devices used during hospitalization; length of stay; discharge status; and medical expense. 8 The J-ASPECT study group has analyzed the DPC database to gain new clinical insights, 7 , 9 – 11 an approach we applied again for this cross-sectional survey.…”

Section: Methodsmentioning

confidence: 99%

Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Kurogi¹,

Nishimura

Nakai³

et al. 2018

Neurology

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ObjectivesThis cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)–associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database.MethodsWe analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge.ResultsDOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039).ConclusionsThis nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

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Section: Methodsmentioning

confidence: 99%

Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Kurogi¹,

Nishimura

Nakai³

et al. 2018

Neurology

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“…However, because of the heterogeneity of MMD, the effects of antiplatelet agents after revascularization remain a matter of debate. Currently, some experts are in favor of aspirin therapy after surgical revascularization since it is associated with angiographic and clinical improvement for a prolonged period ( Onozuka et al, 2016 ). Meanwhile, some data suggest that the overall benefit of aspirin therapy after bypass procedures for preventing recurrent stroke might be reduced due to an increase in the risk of brain hemorrhage ( Kraemer et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of Aspirin Therapy on Bypass Efficacy and Survival of Patients Receiving Direct Cerebral Revascularization

et al. 2022

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Background: Both patency maintenance and neoangiogenesis contribute to cerebrovascular bypass efficacy. However, the combined impact of the aforementioned two indicators on postoperative revascularization following superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass has been less well elucidated. Meanwhile, there is a paucity of evidence with conflicting results about postoperative aspirin therapy.Objective: The objective of the study was to investigate the correlation between aspirin use and STA-MCA bypass efficacy, including patency, postoperative neoangiogenesis, and follow-up outcomes.Methods: A total of 181 MMD patients (201 procedures) undergoing STA-MCA bypass at our institution (2017–2019) were retrospectively reviewed. The bypass efficacy level and postoperative complications were compared between aspirin and non-aspirin groups.Results: Among 95 PS-matched pairs, the aspirin group presented a significantly more favorable bypass efficacy than the non-aspirin group [odds ratio (OR) 2.23, 95% confidence interval (CI) 1.11–4.61; p = 0.026]. Multivariate logistic regression analysis confirmed the profound impact of aspirin as an independent predictor of bypass efficacy [adjusted OR 2.91, 95% CI 1.34–6.68; p = 0.009]. A remarkable negative correlation was found between bypass efficacy and the rate of ischemic complications (Phi = −0.521). Postoperative aspirin therapy was associated with a non-significant trend toward a lower incidence of ischemic events [OR 0.73, 95% CI 0.23–2.19; p = 0.580]. No significant difference in bleeding rates was observed between aspirin and control groups [OR 1.00, 95% CI 0.12–8.48; p = 1.000].Conclusion: Among patients undergoing STA-MCA bypass procedures, bypass efficacy is a good predictor of follow-up outcomes. Postoperative aspirin therapy can improve patency, neoangiogenesis, and overall bypass efficacy, thereby protecting against postoperative ischemic complications.Clinical Trial Registration:http://www.chictr.org.cn/, identifier CTR2100046178.

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“…It allows for the visualization of both the stenotic vessels and detailed mapping of collateral networks which is essential for treatment planning. Medical management in the form of antiplatelet therapy is indicated in all patients with MMD who have suffered from ischemic events [ 17 ]. Aspirin is often used at 50-100 mg daily in children [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Moyamoya Disease in a Young Female With Neurofibromatosis Type 1

Mehkri¹,

Rivas²,

Jules³

et al. 2021

Cureus

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Prehospital antiplatelet use and functional status on admission of patients with non-haemorrhagic moyamoya disease: a nationwide retrospective cohort study (J-ASPECT study)

Cited by 36 publications

References 55 publications

Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Effects of Aspirin Therapy on Bypass Efficacy and Survival of Patients Receiving Direct Cerebral Revascularization

Moyamoya Disease in a Young Female With Neurofibromatosis Type 1

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