Takao Hoshino1,2,3, Leila Sissani1,2, Julien Labreuche2,4, Marie-Germaine Bousser5, Angel Chamorro6, Marc Fisher7, Ian Ford8, Kim M Fox9, Michael G Hennerici10, Heinrich P Mattle11, Peter M Rothwell12, Philippe Gabriel Steg2,9,13, Eric Vicaut14, Pierre Amarenco1,2. 1. Department of Neurology and Stroke Center, Hôpital Bichat, APHP and Université Paris-Diderot-Sorbonne, Paris, France. 2. INSERM Laboratory for Vascular Translational Sciences 1148 and Département Hospitalo-Universitaire FIRE, Paris, France. 3. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. 4. Université de Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Lille, France. 5. Department of Neurology, Hôpital Lariboisière, Paris, France. 6. Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain. 7. Harvard Medical School, Beth Israel Deaconess Medical Center, MA, USA. 8. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK. 9. NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. 10. Department of Neurology, UMM, University of Heidelberg, Mannheim, Germany. 11. Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern, Switzerland. 12. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. 13. Department of Cardiology, Hôpital Bichat, Paris, France. 14. Department of Biostatistics, Hôpital Fernand Widal, Paris, France.
Abstract
INTRODUCTION: We aimed to compare the characteristics and vascular outcomes between Asian and non-Asian patients with non-cardioembolic stroke/transient ischaemic attack receiving antiplatelet monotherapy and to identify population-specific predictors for recurrent events. PATIENTS AND METHODS: We conducted a post-hoc analysis of data from the PERFORM study, in which 19,100 patients (mean age, 67.2 years; male, 63%; 2178 Asian and 16,922 non-Asian patients) with non-cardioembolic ischaemic stroke/transient ischaemic attack were randomised to aspirin or terutroban and followed for two years. The primary outcome was a composite of major adverse cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). RESULTS: There was no difference in major adverse cardiovascular events risk between Asian and non-Asian populations (11.1% vs. 10.5%; p = 0.39). However, Asian patients were at significantly higher risk of intracranial haemorrhage (2.4% vs. 1.3%; hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.34-2.60; p < 0.001) and major bleeding (5.4% vs. 4.1%; HR 1.30; 95% CI 1.04-1.61; p = 0.02). Stroke risk was significantly higher in Asian than in non-Asian populations among patients with lacunar stroke (7.4% vs. 4.5%; p = 0.02). In multivariable analysis, diastolic blood pressure (HR per 5 mm Hg 1.08; 95% CI 1.01-1.16; p = 0.03) and diabetes (HR 1.36; 95% CI 1.22-1.52; p < 0.001) were independent predictors of major adverse cardiovascular events for Asian and non-Asian patients, respectively. Conclusion: Compared with non-Asian patients, Asian patients had significantly higher risk of haemorrhagic events when given antiplatelet monotherapy for secondary prevention after non-cardioembolic stroke/transient ischaemic attack. Lacunar stroke and elevated diastolic blood pressure were more associated with recurrence risk in Asian patients.
INTRODUCTION: We aimed to compare the characteristics and vascular outcomes between Asian and non-Asian patients with non-cardioembolic stroke/transient ischaemic attack receiving antiplatelet monotherapy and to identify population-specific predictors for recurrent events. PATIENTS AND METHODS: We conducted a post-hoc analysis of data from the PERFORM study, in which 19,100 patients (mean age, 67.2 years; male, 63%; 2178 Asian and 16,922 non-Asian patients) with non-cardioembolic ischaemic stroke/transient ischaemic attack were randomised to aspirin or terutroban and followed for two years. The primary outcome was a composite of major adverse cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). RESULTS: There was no difference in major adverse cardiovascular events risk between Asian and non-Asian populations (11.1% vs. 10.5%; p = 0.39). However, Asian patients were at significantly higher risk of intracranial haemorrhage (2.4% vs. 1.3%; hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.34-2.60; p < 0.001) and major bleeding (5.4% vs. 4.1%; HR 1.30; 95% CI 1.04-1.61; p = 0.02). Stroke risk was significantly higher in Asian than in non-Asian populations among patients with lacunar stroke (7.4% vs. 4.5%; p = 0.02). In multivariable analysis, diastolic blood pressure (HR per 5 mm Hg 1.08; 95% CI 1.01-1.16; p = 0.03) and diabetes (HR 1.36; 95% CI 1.22-1.52; p < 0.001) were independent predictors of major adverse cardiovascular events for Asian and non-Asian patients, respectively. Conclusion: Compared with non-Asian patients, Asian patients had significantly higher risk of haemorrhagic events when given antiplatelet monotherapy for secondary prevention after non-cardioembolic stroke/transient ischaemic attack. Lacunar stroke and elevated diastolic blood pressure were more associated with recurrence risk in Asian patients.
Entities:
Keywords:
Antiplatelet; bleeding; cerebrovascular disease; intracranial haemorrhage; race and ethnicity
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