Jin-Man Jung1, Jungsoon Choi2, Mi-Yeon Eun2, Woo-Keun Seo2, Kyung-Hee Cho2, Sungwook Yu2, Kyungmi Oh2, Soonwoong Hong2, Kwang-Yeol Park2. 1. From the Department of Neurology (J.-M.J.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan; the Department of Mathematics (J.C.), School of Natural Sciences, Hanyang University, Seoul; the Department of Neurology (M.-Y.E.), KEPCO Medical Center, Seoul; the Department of Neurology (W.-K.S., K.O.), Korea University Kuro Hospital, Korea University College of Medicine, Seoul; the Department of Neurology (K.-H.C., S.Y., S.H.), Korea University Anam Hospital, Korea University College of Medicine, Seoul; and the Department of Neurology, Chung-Ang University Hospital (K.-Y.P.), Chung-Ang University College of Medicine, Seoul, Korea. sodium75@medimail.co.kr. 2. From the Department of Neurology (J.-M.J.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan; the Department of Mathematics (J.C.), School of Natural Sciences, Hanyang University, Seoul; the Department of Neurology (M.-Y.E.), KEPCO Medical Center, Seoul; the Department of Neurology (W.-K.S., K.O.), Korea University Kuro Hospital, Korea University College of Medicine, Seoul; the Department of Neurology (K.-H.C., S.Y., S.H.), Korea University Anam Hospital, Korea University College of Medicine, Seoul; and the Department of Neurology, Chung-Ang University Hospital (K.-Y.P.), Chung-Ang University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVE: To investigate whether prestroke antiplatelet agent (PA) use was associated with initial stroke severity. METHODS: This was a retrospective, case-control study based on data from a prospectively collected hospital-based stroke registry (Korea University Stroke Registry). A total of 3,025 patients who were admitted with a diagnosis of first-ever ischemic stroke within 5 days of symptom onset were included. Stroke severity was measured with the NIH Stroke Scale (NIHSS). NIHSS score ≤4 at admission was categorized as mild stroke. Patients from the PA group were matched with those from the non-PA group using estimated propensity scores at a 1:1 ratio. Stepwise multivariable logistic regression analyses were performed on patients in the matched datasets with initial mild stroke. RESULTS: Patients' mean age was 66.3 ± 13.0 years, and 1,850 were men (61.5%). A total of 748 patients had been taking antiplatelet agents prior to stroke onset; 644 patients (86.1%) were taking a single antiplatelet agent. Among these agents, aspirin (83.7%) was the most common. A total of 102 patients (13.6%) were taking 2 antiplatelet agents. Multivariable analysis after propensity score matching demonstrated that PA use was associated with initial mild stroke (odds ratio 1.344; 95% confidence interval 1.014-1.782). CONCLUSIONS: PA use was associated with decreased first-ever stroke severity, suggesting that it has a beneficial effect. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that prestroke use of antiplatelet agents reduces stroke severity in patients with first-ever acute ischemic stroke.
OBJECTIVE: To investigate whether prestroke antiplatelet agent (PA) use was associated with initial stroke severity. METHODS: This was a retrospective, case-control study based on data from a prospectively collected hospital-based stroke registry (Korea University Stroke Registry). A total of 3,025 patients who were admitted with a diagnosis of first-ever ischemic stroke within 5 days of symptom onset were included. Stroke severity was measured with the NIH Stroke Scale (NIHSS). NIHSS score ≤4 at admission was categorized as mild stroke. Patients from the PA group were matched with those from the non-PA group using estimated propensity scores at a 1:1 ratio. Stepwise multivariable logistic regression analyses were performed on patients in the matched datasets with initial mild stroke. RESULTS:Patients' mean age was 66.3 ± 13.0 years, and 1,850 were men (61.5%). A total of 748 patients had been taking antiplatelet agents prior to stroke onset; 644 patients (86.1%) were taking a single antiplatelet agent. Among these agents, aspirin (83.7%) was the most common. A total of 102 patients (13.6%) were taking 2 antiplatelet agents. Multivariable analysis after propensity score matching demonstrated that PA use was associated with initial mild stroke (odds ratio 1.344; 95% confidence interval 1.014-1.782). CONCLUSIONS:PA use was associated with decreased first-ever stroke severity, suggesting that it has a beneficial effect. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that prestroke use of antiplatelet agents reduces stroke severity in patients with first-ever acute ischemic stroke.