Antiplatelet therapy following ischaemic stroke – Continue or change pre-existing therapy?

on behalf of the VISTA Collaborators

Research output: Contribution to journalArticle

Abstract

Introduction: Antiplatelet therapy is routinely prescribed early after ischaemic stroke. Many patients will already be taking antiplatelet therapy and it is unknown whether these patients should continue the same antiplatelet treatment or switch to a different regimen. Methods: We selected patients with ischaemic stroke from the Virtual International Stroke Trials Archive database who were prescribed antiplatelets both before and after their stroke and who had detailed records of adverse events after stroke. We compared patients who changed to a new antiplatelet regimen after their stroke to those who continued the same regimen. The primary outcome was recurrent ischaemic stroke within 90 days after their index stroke and the secondary outcome was intracranial haemorrhage (ICH) or extracranial haemorrhage (ECH). We used logistic regression analysis and adjusted for age and baseline NIHSS. Results: A total of 1129 participants were included. Of these, 538 subjects changed antiplatelet regimen post stroke and 591 continued the same regimen. A recurrent ischaemic event occurred in 4.1% of subjects who changed regimen and 4.3% who continued unchanged (adjusted OR = 0.93; 95% CI 0.54–1.75, p = 0.929). The incidence of ICH and ECH within the first 90 days was similar in both groups (2.4% vs. 2.6% (adjusted OR = 1.02; 95% CI 0.48–2.18, p = 0.955) and 4.7% vs. 2.9% (adjusted OR = 1.82; 95% CI 0.96–3.43, p = 0.065), respectively). Discussion: The analysis was performed using a non-randomised registry data. Conclusion: In patients who suffer ischaemic stroke whilst taking antiplatelets, a change in antiplatelet regimen was not associated with an altered risk of early recurrent ischaemic stroke rate or bleeding. However, the results must be interpreted in view of the low event rates.

Original languageEnglish (US)
Pages (from-to)31-36
Number of pages6
JournalEuropean Stroke Journal
Volume2
Issue number1
DOIs
StatePublished - Mar 1 2017

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Stroke
Therapeutics
Intracranial Hemorrhages
Hemorrhage
Registries
Logistic Models
Regression Analysis
Databases
Incidence

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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Antiplatelet therapy following ischaemic stroke – Continue or change pre-existing therapy? / on behalf of the VISTA Collaborators.

In: European Stroke Journal, Vol. 2, No. 1, 01.03.2017, p. 31-36.

Research output: Contribution to journalArticle

on behalf of the VISTA Collaborators. / Antiplatelet therapy following ischaemic stroke – Continue or change pre-existing therapy?. In: European Stroke Journal. 2017 ; Vol. 2, No. 1. pp. 31-36.
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abstract = "Introduction: Antiplatelet therapy is routinely prescribed early after ischaemic stroke. Many patients will already be taking antiplatelet therapy and it is unknown whether these patients should continue the same antiplatelet treatment or switch to a different regimen. Methods: We selected patients with ischaemic stroke from the Virtual International Stroke Trials Archive database who were prescribed antiplatelets both before and after their stroke and who had detailed records of adverse events after stroke. We compared patients who changed to a new antiplatelet regimen after their stroke to those who continued the same regimen. The primary outcome was recurrent ischaemic stroke within 90 days after their index stroke and the secondary outcome was intracranial haemorrhage (ICH) or extracranial haemorrhage (ECH). We used logistic regression analysis and adjusted for age and baseline NIHSS. Results: A total of 1129 participants were included. Of these, 538 subjects changed antiplatelet regimen post stroke and 591 continued the same regimen. A recurrent ischaemic event occurred in 4.1{\%} of subjects who changed regimen and 4.3{\%} who continued unchanged (adjusted OR = 0.93; 95{\%} CI 0.54–1.75, p = 0.929). The incidence of ICH and ECH within the first 90 days was similar in both groups (2.4{\%} vs. 2.6{\%} (adjusted OR = 1.02; 95{\%} CI 0.48–2.18, p = 0.955) and 4.7{\%} vs. 2.9{\%} (adjusted OR = 1.82; 95{\%} CI 0.96–3.43, p = 0.065), respectively). Discussion: The analysis was performed using a non-randomised registry data. Conclusion: In patients who suffer ischaemic stroke whilst taking antiplatelets, a change in antiplatelet regimen was not associated with an altered risk of early recurrent ischaemic stroke rate or bleeding. However, the results must be interpreted in view of the low event rates.",
author = "{on behalf of the VISTA Collaborators} and Wardati Mazlan-Kepli and MacIsaac, {Rachael L.} and Matthew Walters and Bath, {Philip M.W.} and Jesse Dawson and Alexandrov, {A. V.} and Bath, {P. M.W.} and E. Bluhmki and L. Claesson and Andrei Alexandrov and Davis, {S. M.} and G. Donnan and Diener, {H. C.} and M. Fisher and B. Gregson and J. Grotta and W. Hacke and Hennerici, {M. G.} and M. Hommel and M. Kaste and Lees, {K. R.} and P. Lyden and J. Marler and K. Muir and R. Sacco and A. Shuaib and P. Teal and Wahlgren, {N. G.} and S. Warach and C. Weimar",
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AU - on behalf of the VISTA Collaborators

AU - Mazlan-Kepli, Wardati

AU - MacIsaac, Rachael L.

AU - Walters, Matthew

AU - Bath, Philip M.W.

AU - Dawson, Jesse

AU - Alexandrov, A. V.

AU - Bath, P. M.W.

AU - Bluhmki, E.

AU - Claesson, L.

AU - Alexandrov, Andrei

AU - Davis, S. M.

AU - Donnan, G.

AU - Diener, H. C.

AU - Fisher, M.

AU - Gregson, B.

AU - Grotta, J.

AU - Hacke, W.

AU - Hennerici, M. G.

AU - Hommel, M.

AU - Kaste, M.

AU - Lees, K. R.

AU - Lyden, P.

AU - Marler, J.

AU - Muir, K.

AU - Sacco, R.

AU - Shuaib, A.

AU - Teal, P.

AU - Wahlgren, N. G.

AU - Warach, S.

AU - Weimar, C.

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N2 - Introduction: Antiplatelet therapy is routinely prescribed early after ischaemic stroke. Many patients will already be taking antiplatelet therapy and it is unknown whether these patients should continue the same antiplatelet treatment or switch to a different regimen. Methods: We selected patients with ischaemic stroke from the Virtual International Stroke Trials Archive database who were prescribed antiplatelets both before and after their stroke and who had detailed records of adverse events after stroke. We compared patients who changed to a new antiplatelet regimen after their stroke to those who continued the same regimen. The primary outcome was recurrent ischaemic stroke within 90 days after their index stroke and the secondary outcome was intracranial haemorrhage (ICH) or extracranial haemorrhage (ECH). We used logistic regression analysis and adjusted for age and baseline NIHSS. Results: A total of 1129 participants were included. Of these, 538 subjects changed antiplatelet regimen post stroke and 591 continued the same regimen. A recurrent ischaemic event occurred in 4.1% of subjects who changed regimen and 4.3% who continued unchanged (adjusted OR = 0.93; 95% CI 0.54–1.75, p = 0.929). The incidence of ICH and ECH within the first 90 days was similar in both groups (2.4% vs. 2.6% (adjusted OR = 1.02; 95% CI 0.48–2.18, p = 0.955) and 4.7% vs. 2.9% (adjusted OR = 1.82; 95% CI 0.96–3.43, p = 0.065), respectively). Discussion: The analysis was performed using a non-randomised registry data. Conclusion: In patients who suffer ischaemic stroke whilst taking antiplatelets, a change in antiplatelet regimen was not associated with an altered risk of early recurrent ischaemic stroke rate or bleeding. However, the results must be interpreted in view of the low event rates.

AB - Introduction: Antiplatelet therapy is routinely prescribed early after ischaemic stroke. Many patients will already be taking antiplatelet therapy and it is unknown whether these patients should continue the same antiplatelet treatment or switch to a different regimen. Methods: We selected patients with ischaemic stroke from the Virtual International Stroke Trials Archive database who were prescribed antiplatelets both before and after their stroke and who had detailed records of adverse events after stroke. We compared patients who changed to a new antiplatelet regimen after their stroke to those who continued the same regimen. The primary outcome was recurrent ischaemic stroke within 90 days after their index stroke and the secondary outcome was intracranial haemorrhage (ICH) or extracranial haemorrhage (ECH). We used logistic regression analysis and adjusted for age and baseline NIHSS. Results: A total of 1129 participants were included. Of these, 538 subjects changed antiplatelet regimen post stroke and 591 continued the same regimen. A recurrent ischaemic event occurred in 4.1% of subjects who changed regimen and 4.3% who continued unchanged (adjusted OR = 0.93; 95% CI 0.54–1.75, p = 0.929). The incidence of ICH and ECH within the first 90 days was similar in both groups (2.4% vs. 2.6% (adjusted OR = 1.02; 95% CI 0.48–2.18, p = 0.955) and 4.7% vs. 2.9% (adjusted OR = 1.82; 95% CI 0.96–3.43, p = 0.065), respectively). Discussion: The analysis was performed using a non-randomised registry data. Conclusion: In patients who suffer ischaemic stroke whilst taking antiplatelets, a change in antiplatelet regimen was not associated with an altered risk of early recurrent ischaemic stroke rate or bleeding. However, the results must be interpreted in view of the low event rates.

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