Cilostazol Addition to Aspirin could not Reduce the Neurological Deterioration in TOAST Subtypes: ADS Post-Hoc Analysis
| Autor: | Yasuyuki Iguchi, Masaaki Uno, Yoshiki Yagita, Takao Urabe, Junya Aoki, Takeshi Iwanaga, Koji Abe, Takeshi Inoue, Hiroshi Yamagami, Yasumasa Yamamoto, Hideki Matsuoka, Koichi Nomura, Kenichi Todo, Koji Idomari, Nobuaki Yamamoto, Kazumi Kimura, Sen Yamagata, Akira Tsujino, Yasushi Okada, Tadashi Terasaki, Ryota Tanaka, Shigeru Fujimoto, Toshiro Yonehara, Ads investigators, Nobuyuki Kaneko |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Antiplatelet drug Time Factors medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Japan Recurrence Risk Factors Diabetes mellitus Internal medicine Post-hoc analysis Medicine Humans Registries Stroke Aged Randomized Controlled Trials as Topic Retrospective Studies Aspirin business.industry Dual Anti-Platelet Therapy Rehabilitation Odds ratio Middle Aged medicine.disease Cilostazol Blood pressure Treatment Outcome Cardiology Disease Progression Surgery Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 30(2) |
| ISSN: | 1532-8511 |
| Popis: | Background Our previous trial acute dual study (ADS) reported that dual antiplatelet therapy (DAPT) using cilostazol and aspirin did not reduce the rate of short-term neurological worsening in non-cardioembolic stroke patients. Present post-hoc analysis investigated whether the impact of combined cilostazol and aspirin differed among stroke subtypes and factors associated with neurological deterioration and/or stroke recurrence. Methods Using the ADS registry, the rate of neurological deterioration, defined as clinical worsening and/or recurrent stroke, including transient ischemic attack was calculated. Stroke subtypes included large-artery atherosclerosis (LAA), small vessel occlusion (SVO), other determined etiology (Others), and undetermined etiology of stroke (Undetermined). Results Data of 1022 patients were analyzed. Deterioration was seen in 104 (10%) patients, and the rates were not markedly different between patients treated with DAPT vs. aspirin in any stroke subtypes: LAA, 19% vs. 11%, (p=0.192); SVO, 10% vs. 10% (p=1.000); Others, 6% vs. 6% (p=1.000); Undetermined, 11% vs. 8% (p=0.590). Diabetes mellitus was the independent factor associated with deterioration (odds ratio 4.360, 95% confidence interval 1.139–16.691, p=0.032) in the LAA group. Age (1.030 [1.004–1.057], p=0.026), systolic blood pressure (1.012 [1.003–1.022], p=0.010), and infarct size (2.550 [1.488–4.371], p=0.001) were associated with deterioration in SVO group, and intracranial stenosis/occlusion was associated with it in the Undetermined group (3.744 [1.138–12.318], p=0.030). Conclusions Combined cilostazol and aspirin did not reduce the rate of short-term neurological deterioration in any clinical stroke subtype. The characteristics of patients whose condition deteriorates in the acute period may differ based on the stroke subtypes. |
| Databáze: | OpenAIRE |
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