Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

Kim, Joon Tae; Kim, Beom Joon; Park, Jong‐Moo; Lee, Soo Joo; Kwan, Jae; Park, Tai Hwan; Lee, Kyung Bok; Lee, Jun; Hong, Keun Sik; Lee, Byung Chul; Kim, Dong Eog; Choi, Jay Chol; Kwon, Jee Hyun; Shin, Dong Ick; Sohn, Sung Il; Lee, Ji Sung; Lee, Jun-Young; Bae, Hee Joon

doi:10.1038/s41598-020-73836-0

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…Despite the efforts of researchers and pharmaceutical companies, the risk of stroke recurrence remains high ( 19 ). The use of antiplatelet agents is recommended to reduce the long-term risk of non-cardioembolic ischemic stroke or TIA ( 20 ). Aspirin is a commonly used antiplatelet agent for secondary stroke prevention, but its benefit must be weighed against its bleeding risks, particularly in the aging population ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…The use of antiplatelet agents is recommended to reduce the long-term risk of non-cardioembolic ischemic stroke or TIA ( 20 ). Aspirin is a commonly used antiplatelet agent for secondary stroke prevention, but its benefit must be weighed against its bleeding risks, particularly in the aging population ( 20 ). It has been proved that aspirin is safe and beneficial in preventing stroke recurrence, but aspirin can only reduce recurrent vascular events by 20% ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

Chai

Chen

et al. 2022

Front. Neurol.

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BackgroundCilostazol is often used in Asia-Pacific countries for stroke prevention. The current systematic review and meta-analysis aimed to evaluate the effectiveness, safety, and adverse outcomes of cilostazol monotherapy compared to aspirin monotherapy for secondary stroke prevention.MethodsThe researchers conducted a comprehensive research in multiple databases (PubMed, Embase, and Cochrane library) of randomized controlled trials from conception to December 2020. The primary efficacy outcome was the occurrence of any stroke, the primary safety outcome was the bleeding risk, and the primary adverse outcome was the rate of headache and dizziness. The Mantel-Haenszel method was used to calculate a random-effects prediction. Cilostazol and aspirin were compared using a pooled risk assessment with 95% CIs.ResultsSix studies involving 5,617 patients were included in this review. Compared with aspirin monotherapy, cilostazol was associated with significantly lower rates of any strokes (RR: 0.67; 95% CI: 0.55–0.82) and significantly lower bleeding rates [risk ratio (RR): 0.53; 95% CI: 0.37–0.74]. However, compared with aspirin monotherapy, cilostazol was associated with significantly higher rates of headache (RR: 1.77; 95% CI: 1.41–2.20) and dizziness (RR: 1.28; 95% CI: 1.08–1.52).ConclusionsConsistent with previous studies, cilostazol monotherapy is superior to aspirin monotherapy in reducing the rate of any strokes and the bleeding risk after having a stroke. However, the use of cilostazol monotherapy is associated with several adverse life outcomes such as headaches and dizziness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

Chai

Chen

et al. 2022

Front. Neurol.

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“…However, a trend of radical antiplatelet therapy was shown during the period of the guideline update. Kim et al [ 28 ] reported that a large atherosclerotic burden might affect the selection of a combination of DAPT. Similarly, the large-artery atherosclerosis patients in our study were likely to be treated positively.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Features of In-Hospital Recurrence in Acute Ischaemic Stroke Patients over Time: A Real-World Observation at a Single Center

et al. 2022

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Acute ischaemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. Our study aimed to assess the clinical characteristics and risk factors of in-hospital ischaemic recurrence in AIS patients in different periods. This study was a retrospective, single-center analysis. The patients were divided into two stages based on their admission time. The primary endpoint was recurrent stroke during hospitalization. In total, 978 patients in Stage 1 and 1047 patients in Stage 2 were included in this study. The in-hospital recurrence rate in Stage 1 was 5.9%, while that in Stage 2 was 4.0% (p = 0.046). A recurrence rate reduction mainly occurred in the minor stroke and large-artery atherosclerosis (LAA) stroke patients. Infection was an independent risk factor despite amelioration by antiplatelet therapy (p < 0.001). Diabetes patients also had a higher risk of in-hospital ischaemic recurrence among the minor stroke and large-artery atherosclerosis patients. A positive attitude towards antiplatelet therapy failed to completely halt recurrence of the disease. In conclusion, the rate of in-hospital ischaemic recurrence in AIS patients showed a decreasing trend over time, especially in the minor stroke and large-artery atherosclerosis stroke patients. Infection and diabetes were associated with a higher risk of stroke recurrence.

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“…4. Subjects, predicted in the low-risk profile of recurrent stroke, Essen stroke risk scores ≤ 3 points; [ 15 ]…”

Section: Methodsmentioning

confidence: 99%

“…4. Subjects, predicted in the low-risk profile of recurrent stroke, Essen stroke risk scores ≤ 3 points; [15] 5. Only taking single antiplatelet drug, not overlapping the use of activating blood and removing stasis herbs medicine;…”

Section: Study Population 231 Inclusion Criteria 1subjects Diagnosed ...mentioning

confidence: 99%

To study the mechanism of panax notoginseng in the treatment of aspirin resistance in the secondary prevention of stroke based on TLR4/MyD88/NF-κB signaling pathway: A study protocol

Wang

Yuan

Wang³

et al. 2022

Medicine

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Introduction: Aspirin, as an typical antiplatelet therapy for secondary stroke prevention, have been proved that can significantly reduce incidence and recurrence of cerebrovascular ischemic events. However, due to drugs biological characteristics, aspirin resistance (AR) often occurs in clinical practice, which significantly influence secondary prevention in stroke patients. The growing evidence of activating blood and removing stasis herbs medicine (Sanqi) for AR is promising. However, the efficacy and mechanism of Panax notoginseng (Sanqi) for AR in secondary stroke prevention has not been confirmed. Methods/design: This is a prospective 2-center, assessor and statistician blinded, randomized, controlled trial. We will allocate 106 subjects aged between 45 and 65 years old, diagnosed with aspirin semi-resistance after stroke to 2 groups randomly in a ratio of 1:1. Patients in the experimental group will be treated with conventional treatments plus Panax notoginseng (Sanqi) while the others in the control group will be treated with only conventional treatments. All will be given different medications for 30 days. Patients will be measured with the platelet aggregation rate and serum TLR4, MyD88, NF-κB, COX-2, IL-6, CRP, TXB2 level for clinical efficacy and mechanisms at baseline and the 14th, 30th day of treatment. Baseline characteristics of patients will be summarized by groups and compared with Chi-square for categorical variables, and Student’s independent t test or nonparametric Mann-Whitney U test for the continuous variables. Primary and secondary outcomes will be analyzed with 2-way repeated measures Anova, and Post Hoc test. Conclusion: The present study aims to investigate short-term add-on efficacy and mechanism of Panax notoginseng (Sanqi) for aspirin resistance in secondary stroke prevention via TLR4/MyD88/NF-κB signaling pathway. With this, we expect to find out an appropriate partial substitute of aspirin for aspirin resistance individuals. Trial Registration: The trial was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) with the ID ChiCTR2100045773 at April 24, 2021.

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Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

Cited by 8 publications

References 36 publications

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

The Clinical Features of In-Hospital Recurrence in Acute Ischaemic Stroke Patients over Time: A Real-World Observation at a Single Center

To study the mechanism of panax notoginseng in the treatment of aspirin resistance in the secondary prevention of stroke based on TLR4/MyD88/NF-κB signaling pathway: A study protocol

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