Exploring Sex Differences in Outcomes of Dual Antiplatelet Therapy for Patients With Noncardioembolic Mild-to-Moderate Ischemic Stroke or High-Risk Transient Ischemic Attack: A Propensity-Matched Analysis of the READAPT Study Cohort.
| Autor: | Foschi M; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.)., D'Anna L; Department of Brain Sciences, Imperial College London, United Kingdom (L.D.A., E.D.M.).; Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, United Kingdom (L.D.A., E.D.M.)., De Matteis E; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.).; Department of Brain Sciences, Imperial College London, United Kingdom (L.D.A., E.D.M.).; Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, United Kingdom (L.D.A., E.D.M.)., De Santis F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.)., Romoli M; Department of Neuroscience, Stroke Unit, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy (M. Romoli)., Tassinari T; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy (T.T., V.S.)., Saia V; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy (T.T., V.S.)., Cenciarelli S; Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)., Bedetti C; Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)., Padiglioni C; Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)., Censori B; Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V.)., Puglisi V; Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V.)., Vinciguerra L; Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V.)., Guarino M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy (M.G., V.B.)., Barone V; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy (M.G., V.B.)., Zedde M; Department of Neurology, AUSL-IRCCS di Reggio Emilia, Italy (M.Z., I.G.)., Grisendi I; Department of Neurology, AUSL-IRCCS di Reggio Emilia, Italy (M.Z., I.G.)., Diomedi M; Department of Systems Medicine, Tor Vergata University, Rome, Italy (M.D., M.R. Bagnato)., Bagnato MR; Department of Systems Medicine, Tor Vergata University, Rome, Italy (M.D., M.R. Bagnato)., Petruzzellis M; Department of Neurology, Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy (M. Petruzzellis, D.M.M.)., Mezzapesa DM; Department of Neurology, Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy (M. Petruzzellis, D.M.M.)., Di Viesti P; Department of Neurology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (P.D.V., V.I.)., Inchingolo V; Department of Neurology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (P.D.V., V.I.)., Cappellari M; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy (M. Cappellari, C.Z.)., Zivelonghi C; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy (M. Cappellari, C.Z.)., Candelaresi P; Department of Neurology, Stroke Unit, AORN Antonio Cardarelli, Naples, Italy (P.C., V.A.)., Andreone V; Department of Neurology, Stroke Unit, AORN Antonio Cardarelli, Naples, Italy (P.C., V.A.)., Rinaldi G; Department of Neurology, Di Venere Hospital, Bari, Italy (G. Rinaldi, A.B.)., Bavaro A; Department of Neurology, Di Venere Hospital, Bari, Italy (G. Rinaldi, A.B.)., Cavallini A; Dipartimento Testa Collo, Neurologia d'Urgenza-Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini, S.M.)., Moraru S; Dipartimento Testa Collo, Neurologia d'Urgenza-Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini, S.M.)., Piscaglia MG; Department of Neuroscience, Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy (M.G.P.)., Terruso V; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy (V.T., M. Mannino)., Mannino M; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy (V.T., M. Mannino)., Pezzini A; Department of Medicine and Surgery, University of Parma, Italy (A.P.).; Stroke Care Program, Department of Emergencies, Parma University Hospital, Italy (A.P.)., Frisullo G; Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy (G.F.)., Muscia F; Department of Neurology, ASST-Ovest Milanese, Legnano, Italy (F.M.)., Paciaroni M; Department of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy (M. Paciaroni, M.G.M.).; Unit of Clinical Neurology, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy (M. Paciaroni)., Mosconi MG; Department of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy (M. Paciaroni, M.G.M.)., Zini A; IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Italy (A.Z.)., Leone R; Department of Neurology, Stroke Unit, 'M. R. Dimiccoli' Hospital, Barletta, Italy (R.L.)., Palmieri C; Department of Neurology, Stroke Unit, E. Agnelli Hospital, Pinerolo, Italy (C. Palmieri)., Cupini LM; Department of Neurology, Stroke Unit, S. Eugenio Hospital, Rome, Italy (L.M.C.)., Marcon M; Department of Neurology, Cazzavillan Hospital, Arzignano, Italy (M. Marcon)., Tassi R; Dipartimento di Emergenza-Urgenza, Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy (R. Tassi)., Sanzaro E; Department of Neurology, Neurology Unit, Umberto I Hospital, Siracusa, Italy (E.S.)., Papiri G; Department of Neurology, Stroke Unit, Ospedale 'Madonna del Soccorso,' San Benedetto del Tronto, Italy (G. Papiri, C. Paci)., Paci C; Department of Neurology, Stroke Unit, Ospedale 'Madonna del Soccorso,' San Benedetto del Tronto, Italy (G. Papiri, C. Paci)., Viticchi G; Experimental and Clinical Medicine Department, Marche Polytechnic University, Ancona (G. Viticchi)., Orsucci D; Department of Neurology, Neurology Unit, San Luca Hospital, Lucca and Castelnuovo Garfagnana, Italy (D.O.)., Falcou A; Dipartimento di Emergenza-Urgenza, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy (A. Falcou)., Beretta S; Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (S.B.)., Tarletti R; Dipartimento di Emergenza-Urgenza, Stroke Unit, Azienda Ospedaliero-Universitaria 'Maggiore della Carità,' Novara, Italy (R. Tarletti)., Nencini P; Dipartimento di Emergenza-Urgenza, Stroke Unit, Careggi University Hospital, Florence, Italy (P.N.)., Rota E; Department of Neurology, Stroke Unit, San Giacomo Hospital, Novi Ligure, Italy (E.R.)., Sepe FN; Dipartimento di Emergenza-Urgenza, Stroke Unit, SS. Biagio e Arrigo, Alessandria, Italy (F.N.S., D.F.)., Ferrandi D; Dipartimento di Emergenza-Urgenza, Stroke Unit, SS. Biagio e Arrigo, Alessandria, Italy (F.N.S., D.F.)., Caputi L; Department of Cardiocerebrovascular Diseases, Stroke Unit, ASST Ospedale Maggiore di Crema, Italy (L.C.)., Volpi G; Department of Neurology, Stroke Unit, San Jacopo Hospital, Pistoia, Italy (G. Volpi)., La Spada S; Department of Neurology, Stroke Unit, Antonio Perrino Hospital, Brindisi, Italy (S.L.S.)., Beccia M; Department of Neurology, Stroke Unit, Sant'Andrea Hospital, Rome, Italy (M.B.)., Rinaldi C; Department of Neuroscience, Neurology Unit, 'Infermi' Hospital, AUSL Romagna, Rimini, Italy (C. Rinaldi, V.M.)., Mastrangelo V; Department of Neuroscience, Neurology Unit, 'Infermi' Hospital, AUSL Romagna, Rimini, Italy (C. Rinaldi, V.M.)., Di Blasio F; Dipartimento di Emergenza-Urgenza, Stroke Unit, 'S.Spirito' Hospital, Pescara, Italy (F.D.B., M.V.D.A.)., Invernizzi P; Departiment of Neurology, Stroke Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (P.I.)., Pelliccioni G; Department of Neurology, IRCCS-INRCA, Ancona, Italy (G. Pelliccioni)., De Angelis MV; Dipartimento di Emergenza-Urgenza, Stroke Unit, 'S.Spirito' Hospital, Pescara, Italy (F.D.B., M.V.D.A.).; Department of Neurology, SS Annunziata Hospital, Chieti, Italy (M.V.D.A.)., Bonanni L; Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio di Chieti-Pescara, Italy (L. Bonanni)., Ruzza G; Department of Neurology, Stroke Unit, Civil Hospital, Cittadella, Italy (G. Ruzza)., Caggia EA; Cardio-Neuro-Vascular Department, Neurology Unit, Giovanni Paolo II Hospital, Ragusa, Italy (E.A.C.)., Russo M; Department of Neurology, Stroke Unit, St Misericordia Hospital, Rovigo, Italy (M. Russo)., Tonon A; Department of Neurology, Stroke Unit, Ospedale Civile Ss. Giovanni e Paolo, Venezia, Italy (A.T.)., Acciarri MC; Department of Neurology, Stroke Unit, A. Murri Fermo Hospital, Fermo, Italy (M.C.A.)., Anticoli S; UOSD Stroke Unit, Azienda Ospedaliera San Camillo, Rome, Italy (S.A.)., Roberti C; Department of Neurology, Stroke Unit, San Filippo Neri Hospital, Rome, Italy (C. Roberti)., Manobianca G; Department of Neurology, Stroke Unit, General Regional Hospital 'F. Miulli,' Acquaviva delle Fonti, Italy (G.M., G.S.)., Scaglione G; Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy (A. Fortini)., Pistoia F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.)., Fortini A; Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy (A. Fortini)., De Boni A; Department of Neuroscience, Stroke Unit, San Bortolo Hospital, Vicenza, Italy (A.D.B.)., Sanna A; Department of Neurology, Stroke Unit, AOU Sassari, Italy (A.S.)., Chiti A; Department of Neurology, Neurology Unit, Apuane Hospital, Massa Carrara, Italy (A. Chiti)., Barbarini L; Department of Neurology, Stroke Unit, Vito Fazi Hospital, Lecce, Italy (L. Barbarini, M. Caggiula)., Caggiula M; Department of Neurology, Stroke Unit, Vito Fazi Hospital, Lecce, Italy (L. Barbarini, M. Caggiula)., Masato M; Department of Neurology, Stroke Unit, Mirano Hospital, Italy (M. Masato)., Del Sette M; Department of Neuroscience, Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy (M.D.S.)., Passarelli F; Department of Neurology, Stroke Unit, Fatebenefratelli Hospital, Rome, Italy (F. Passarelli)., Bongioanni MR; Department of Neurology, Stroke Unit, SS Annunziata Hospital, Savigliano, Italy (M.R. Bongioanni)., De Michele M; Department of Human Neurosciences, Stroke Unit, La Sapienza University, Rome, Italy (M.D.M.)., Ricci S; Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.).; Coordinatore Comitato Scientifico ISA-AII, Città di Castello, Italy (S.R.)., Ornello R; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.)., Sacco S; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (M.F., E.D.M., F.D.S., F. Pistoia, R.O., S.S.). |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Stroke [Stroke] 2024 Dec 09. Date of Electronic Publication: 2024 Dec 09. |
| DOI: | 10.1161/STROKEAHA.124.049210 |
| Abstrakt: | Background: Sex may impact clinical outcomes in patients with stroke treated with dual antiplatelet therapy (DAPT). We aimed to investigate the sex differences in the short-term outcomes of DAPT within a real-world population of patients with noncardioembolic mild-to-moderate ischemic stroke or high-risk transient ischemic attack. Methods: We performed a propensity score-matched analysis from a prospective multicentric cohort study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]) by including patients with noncardioembolic mild-to-moderate stroke (National Institutes of Health Stroke Scale score of 0-10) or high-risk transient ischemic attack (age, blood pressure, clinical features, duration of transient ischemic attack, presence of diabetes [ABCD Results: From 2278 patients in the READAPT study cohort, we included 1643 mild-to-moderate strokes or high-risk transient ischemic attacks treated with DAPT (mean age, 69.8±12.0 years; 34.3% women). We matched 531 women and men. The 90-day risk of new ischemic stroke or other vascular events was significantly lower among women than men (hazard ratio, 0.53 [95% CI, 0.28-0.99]; P =0.039). There were no significant differences in secondary effectiveness outcomes. The 90-day risk of safety outcomes was extremely low and did not differ between women and men (moderate-to-severe bleedings: 0.4% versus 0.8%; P =0.413; symptomatic intracranial hemorrhage: 0.2% versus 0.4%; P =0.563). Subgroup analysis for primary effectiveness outcome showed a lower 90-day risk of new ischemic stroke or other vascular events among women aged <50 years, baseline National Institutes of Health Stroke Scale score of 0 to 5, prestroke modified Rankin Scale score <2, large artery atherosclerosis cause, and no diabetes. Conclusions: Our findings suggest that women with noncardioembolic mild-to-moderate stroke or high-risk transient ischemic attack treated with DAPT may have lower short-term risk of recurrent ischemic events than men. Further research is needed to understand the mechanisms behind potential sex-based differences in outcomes after DAPT use. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|