Prestroke antiplatelet agents in first-ever ischemic stroke

Jung, Jin‐Man; Choi, Jungsoon; Eun, Mi-Yeon; Seo, Woo Keun; Cho, Kyung Hee; Yu, Sungwook; Oh, Kyungmi; Hong, Soonwoong; Park, Kwang‐Yeol

doi:10.1212/wnl.0000000000001361

Cited by 20 publications

(20 citation statements)

References 38 publications

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“…Details of the KUSR are described elsewhere. 8 In brief, 3 university hospitals located in a separate urban area have been participating in the KUSR and sharing electronic documentation in KUSR format. Clinical, laboratory, and radiological data were consecutively collected in patients with acute ischemic stroke, within 7 days from symptom onset.…”

Section: Data Collection Based On Stroke Registrymentioning

confidence: 99%

Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke

Jung

Kim

et al. 2016

Stroke

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Background and Purpose-We investigated clinical and radiological characteristics of ischemic stroke patients with Takotsubo-like myocardial dysfunction. Methods-From multicenter stroke registry database, ischemic stroke patients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review. Conclusion-Stroke patients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.

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Section: Data Collection Based On Stroke Registrymentioning

confidence: 99%

Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke

Jung

Kim

et al. 2016

Stroke

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“…This study is a substudy of a previous report in which patients were selected from a prospectively collected stroke registry (Korea University Stroke Registry) involving the Anam, Guro, and Ansan University Hospitals [7] . Patients admitted to Anam and Guro University Hospitals from October 2007 to September 2012 and Ansan University Hospital from October 2009 to September 2012 were screened ( fig.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Routine evaluation, including vascular risk factors, laboratory findings, history of prior medications, and brain imaging, was performed according to previously reported definitions and methods [7,8] .…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…91 ple t-test or Mann-Whitney U test was used based on whether the distribution of variables was normal or not, respectively. According to the methods previously reported [7] , missing values were imputed into the unmatched dataset and a propensity matched dataset was created. To balance the baseline characteristics, we used an estimated logit width of 0.1 SD for patient matching.…”

Section: Stroke Subtypesmentioning

confidence: 99%

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Prestroke Antiplatelet Agents in First-Time Ischemic Stroke Are Related to Subtypes

Jung¹,

Cha

Choi

et al. 2016

Eur Neurol

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Background: It is not well known whether prestroke antiplatelet agents (PAs) are associated with the subtypes of ischemic stroke. Methods: We screened patients in a hospital-based stroke registry. Patients who were admitted with a diagnosis of first-time ischemic stroke within 5 days of symptom onset were included. Ischemic stroke subtypes were classified in accordance with the Trial of ORG 10172 in Acute Stroke Treatment classification based on stroke mechanism: large-artery atherosclerosis (LA), cardioembolism (CE), small vessel occlusion (SVO), other determined (OC) or undetermined causes (UC). Multinomial logistic regression analyses were performed to evaluate the effect of PA on stroke subtypes before and after propensity score matching. Results: Among 3,025 patients, 748 (24.7%) were taking antiplatelet agents prior to stroke. After propensity score matching, 1,190 patients were ultimately included. The PA group was associated with strokes caused by SVO rather than LA in multinomial logistic regression of an unmatched dataset. However, multivariable analysis after propensity score matching demonstrated that PA use was associated with a higher probability of SVO and CE (OR 2.05, p < 0.001 and OR 1.62, p = 0.05, respectively) compared with LA. Conclusions: PAs were associated with specific index stroke subtypes.

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“…In addition to the reduced risk of non-cardioembolic stroke with antiplatelet treatment, some studies suggested that patients who are receiving aspirin prior to stroke experience less severe stroke and have better outcomes [11][12][13][14] . However, other reports did not confirm these beneficial effects of aspirin [15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

Τζιόμαλος

Giampatzis²,

Bouziana³

et al. 2016

Cerebrovasc Dis

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Background: Clopidogrel reduces the risk of non-cardioembolic ischemic stroke, but it is unclear whether it affects the severity and outcome of stroke. We aimed at evaluating the effect of prior treatment with clopidogrel on acute non-cardioembolic ischemic stroke severity and in-hospital outcome. Methods: We prospectively studied 608 consecutive patients (39.5% males, age 79.1 ± 6.6 years) who were admitted with acute ischemic stroke. The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥21. The outcome was assessed using the dependency rates that prevailed at the time of discharge (i.e. modified Rankin scale between 2 and 5) and with in-hospital mortality. Results: At admission, 397 patients did not have atrial fibrillation or heart valve disease. Among these 397 patients, 69 were receiving monotherapy with clopidogrel prior to stroke, 69 were receiving monotherapy with aspirin and 236 patients were not on any antiplatelet treatment. The prevalence of severe stroke was lower in patients who were receiving clopidogrel than in patients who were receiving aspirin and patients who were not on antiplatelets (1.4, 13.0 and 11.0%, respectively; p < 0.05). Independent predictors of severe stroke at admission were male gender (relative risk (RR) 0.31, 95% CI 0.12-0.78, p < 0.05) and treatment with clopidogrel prior to stroke compared with no antiplatelet treatment (RR 0.13, 95% CI 0.02-0.97, p < 0.05). Treatment with aspirin prior to stroke did not predict severe stroke compared with no antiplatelet treatment (RR 1.24, 95% CI 0.51-2.98, p = NS). The rate of dependency at discharge did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (57.9, 47.8 and 59.7%, respectively; p = NS). Independent predictors of dependency at discharge were age (RR 1.12, 95% CI 1.05-1.19, p < 0.001) and NIHSS at admission (RR 1.67, 95% CI 1.46-1.92, p < 0.001). In-hospital mortality rate also did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (4.3, 4.3 and 5.0%, respectively; p = NS). The only independent predictor of in-hospital mortality was NIHSS at admission (RR 1.22, 95% CI 1.14-1.30, p < 0.001). Conclusions: Treatment with clopidogrel prior to acute non-cardioembolic ischemic stroke attenuates the severity of stroke at admission but does not appear to affect the functional outcome at discharge or the in-hospital mortality of these patients.

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Prestroke antiplatelet agents in first-ever ischemic stroke

Abstract: This study provides Class II evidence that prestroke use of antiplatelet agents reduces stroke severity in patients with first-ever acute ischemic stroke.

Cited by 20 publications

References 38 publications

Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke

Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke

Prestroke Antiplatelet Agents in First-Time Ischemic Stroke Are Related to Subtypes

Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

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