Abstract
BACKGROUND: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments.
METHODS: Patients who were discharged with first-time ischemic stroke from 2007-2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen.
RESULTS: Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95% confidence interval [CI]: 0.89-1.17) for ischemic stroke and 1.06 (95% CI: 0.83-1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95% CI: 1.31-1.67) for stroke and 1.47 (95% CI: 1.18-1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95% CI: 0.59-0.81) and 0.72 (95% CI: 0.55-0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95% CI: 10.2-12.2), 7.7 (95% CI: 7.3-8.3), and 8.0 (95% CI: 6.9-8.7) for ischemic stroke, respectively; while, the risks for bleeding were 3.4 (95% CI: 2.8-3.9), 2.4 (95% CI: 2.1-2.7), and 2.4 (95% CI: 1.9-2.9), respectively.
CONCLUSION: Clopidogrel and the combination of acetylsalicylic acid and dipyridamole were associated with similar risks for recurrent ischemic stroke and bleeding; whereas acetylsalicylic acid was associated with higher risks for both ischemic stroke and bleeding. The latter finding may partially be explained by selection bias.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | BMC Neurology |
| Vol/bind | 15 |
| Udgave nummer | 1 |
| Sider (fra-til) | 225 |
| ISSN | 1471-2377 |
| DOI | |
| Status | Udgivet - 2015 |
Finansiering
CC received a grant from The Danish Heart Foundation. The Danish Heart Foundation was not involved in the design, data collection, interpretation of data, the writing of the manuscript, or in the decision to submit the manuscript for publication. GG received a grant and personal fees from AstraZeneca, grants from Bristol Meyers Squibb, and grants and personal fees from Pfizer and was also supported by an unrestricted clinical research scholarship from the Novo Nordisk Foundation. JBO has received speaker fees from Bristol-Myers Squibb and Boehringer Ingelheim and funding for research from the Lundbeck Foundation, Bristol-Myers Squibb, and The Capital Region of Denmark, Foundation for Health Research. CTP received grants from Pfizer, MSD, Sanofi, and Cardiome. AKN received a research grant from Helsefonden. JP has been supported by an unrestricted research grant from Boehringer-Ingelheim. MEJ, SLK and TAG report no funding related to this study. NC received a grant from the Danish Heart foundation unrelated to this study. None of the funding bodies played any role in the collection, analysis, or interpretation of data; in the writing of the manuscript; or the decision to submit the manuscript for publication.
Fingeraftryk
Dyk ned i forskningsemnerne om 'Comparison of antiplatelet regimens in secondary stroke prevention: a nationwide cohort study'. Sammen danner de et unikt fingeraftryk.Citationsformater
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver