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

Mazlan-Kepli, W., Macisaac, R. L., Walters, M. , Bath, P. M.W. and Dawson, J. (2017) Antiplatelet therapy following ischaemic stroke – continue or change pre-existing therapy? European Stroke Journal, 2(1), pp. 31-36. (doi:10.1177/2396987316678728)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mazlan Kepli, Wardati and Macisaac, Dr Rachael and Dawson, Professor Jesse and Walters, Professor Matthew
Authors: Mazlan-Kepli, W., Macisaac, R. L., Walters, M., Bath, P. M.W., and Dawson, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Stroke Journal
Publisher:SAGE
ISSN:2396-9873
ISSN (Online):2396-9881
Published Online:04 November 2016
Copyright Holders:Copyright © 2016 European Stroke Organisation
First Published:First published in European Stroke Journal 2(1):31-36
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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