Characterization of patients with embolic strokes of undetermined source in the NAVIGATE ESUS randomized trial

Kasner, S. E. et al. (2018) Characterization of patients with embolic strokes of undetermined source in the NAVIGATE ESUS randomized trial. Journal of Stroke and Cerebrovascular Diseases, 27(6), pp. 1673-1682. (doi:10.1016/j.jstrokecerebrovasdis.2018.01.027) (PMID:29525076)

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Abstract

Background: The New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs. ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is a randomized phase-III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. Aims: We aimed to describe the baseline characteristics of this large ESUS cohort to explore relationships among key subgroups. Methods: We enrolled 7213 patients at 459 sites in 31 countries. Prespecified subgroups for primary safety and efficacy analyses included age, sex, race, global region, stroke or transient ischemic attack prior to qualifying event, time to randomization, hypertension, and diabetes mellitus. Results: Mean age was 66.9 ± 9.8 years; 24% were under 60 years. Older patients had more hypertension, coronary disease, and cancer. Strokes in older subjects were more frequently cortical and accompanied by radiographic evidence of prior infarction. Women comprised 38% of participants and were older than men. Patients from East Asia were oldest whereas those from Latin America were youngest. Patients in the Americas more frequently were on aspirin prior to the qualifying stroke. Acute cortical infarction was more common in the United States, Canada, and Western Europe, whereas prior radiographic infarctions were most common in East Asia. Approximately forty-five percent of subjects were enrolled within 30 days of the qualifying stroke, with earliest enrollments in Asia and Eastern Europe. Conclusions: NAVIGATE-ESUS is the largest randomized trial comparing antithrombotic strategies for secondary stroke prevention in patients with ESUS. The study population encompasses a broad array of patients across multiple continents and these subgroups provide ample opportunities for future research.

Item Type:Articles
Additional Information:Sponsored by Bayer AG and Janssen Research and Development; partial funding for the Biomarker, Genetics, Gene Expression Substudy from the Canadian Stroke Prevention Intervention Network.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Kasner, S. E., Lavados, P., Sharma, M., Wang, Y., Wang, Y., Dávalos, A., Shamalov, N., Cunha, L., Lindgren, A., Mikulik, R., Arauz, A., Lang, W., Czlonkowska, A., Eckstein, J., Gagliardi, R., Amarenco, P., Ameriso, S. F., Tatlisumak, T., Veltkamp, R., Hankey, G. J., Toni, D. S., Bereczki, D., Uchiyama, S., Ntaios, G., Yoon, B.-W., Brouns, R., Endres, M., Muir, K., Bornstein, N., Ozturk, S., O'Donnell, M., Mundl, H., Pater, C., Weitz, J., Peacock, W. F., Swaminathan, B., Kirsch, B., Berkowitz, S. D., Peters, G., Pare, G., Themeles, E., Shoamanesh, A., Connolly, S. J., and Hart, R. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:Journal of Stroke and Cerebrovascular Diseases
Publisher:Elsevier
ISSN:1052-3057
ISSN (Online):1532-8511
Published Online:07 March 2018
Copyright Holders:Copyright © 2018 National Stroke Association
First Published:First published in Journal of Stroke and Cerebrovascular Diseases 27(6): 1673-1682
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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