Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy
| Autor: | Alfredo Firstenfeld, Robert G. Hart, Hardi Mundl, Robert Mikulik, Shinichiro Uchiyama, Scott D. Berkowitz, Scott E. Kasner, Pablo M. Lavados, Sebastián F. Ameriso, Guillermo Povedano, Stuart J. Connolly, George Ntaios, Wilfried Lang, Kanjana S Perera, Lesly A. Pearce, Jorge Ferrari, Pierre Amarenco, Dániel Bereczki, Byung-Woo Yoon |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.drug_class Risk Assessment Magnetic resonance angiography law.invention Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Double-Blind Method Fibrinolytic Agents Rivaroxaban Randomized controlled trial Recurrence Risk Factors law Internal medicine Antithrombotic Prevalence medicine Humans Aged Aspirin medicine.diagnostic_test business.industry Rehabilitation Anticoagulant Odds ratio Middle Aged Intracranial Arteriosclerosis 3. Good health Stroke Treatment Outcome Intracranial Embolism Cohort Cardiology Female Surgery Neurology (clinical) Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors 030217 neurology & neurosurgery Factor Xa Inhibitors medicine.drug |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 29:104936 |
| ISSN: | 1052-3057 |
| DOI: | 10.1016/j.jstrokecerebrovasdis.2020.104936 |
| Popis: | Background Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. Methods Exploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed. Results Among 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5). Conclusions East Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. |
| Databáze: | OpenAIRE |
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