1. [The association of lipid profile and bleeding in patients with minor stroke or transient ischemic attack on antiplatelet therapy: subgroup analysis of CHANCE].
- Author
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Li JJ, Gu HQ, Peng YJ, Zhao XQ, Wang YL, Meng X, Liu LP, and Wang YJ
- Subjects
- Aspirin administration & dosage, Clopidogrel, Drug Therapy, Combination, Humans, Ischemic Attack, Transient drug therapy, Platelet Aggregation Inhibitors administration & dosage, Proportional Hazards Models, Risk Factors, Stroke drug therapy, Ticlopidine administration & dosage, Ticlopidine adverse effects, Tissue Plasminogen Activator, Treatment Outcome, Aspirin adverse effects, Hemorrhage chemically induced, Ischemic Attack, Transient complications, Lipids blood, Platelet Aggregation Inhibitors adverse effects, Stroke complications, Ticlopidine analogs & derivatives
- Abstract
Objective: Abnormalities of lipid profile were considered as risk factors of hemorrhage after ischemic stroke. We aimed to determine the relationship between lipid levels and bleeding in minor stroke or transient ischemic attack (TIA) patients receiving antiplatelet therapy. Methods: Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride were tested in a subgroup of 3 044 consecutive patients from Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Patients were randomized to clopidogrel plus aspirin group or single aspirin group. The primary endpoint was any bleeding within 90 days. The secondary endpoint was severe bleeding according to the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) definition. Cox proportional hazards models were used to assess the associations of lipid levels and outcomes. Results: A total of 59 (1.9%) bleeding events occurred at 90 days. High-density lipoprotein cholesterol (adjusted HR =2.16; 95 %CI 1.17-4.00, P= 0.014) and age (adjusted HR =1.04; 95 %CI 1.01-1.06, P= 0.006) were significantly associated with any bleeding. High-density lipoprotein cholesterol was also associated with severe bleeding (adjusted HR =3.05; 95 %CI 1.39-6.68, per 1 mmol/L increase). No correlations between outcomes and levels of total cholesterol, low-density lipoprotein cholesterol and triglyceride were found. There was no interaction of any lipid component level with randomized antiplatelet therapy. Conclusions: Elevated high-density lipoprotein cholesterol is independently associated with any bleeding and severe bleeding in the patients with acute minor stroke or high-risk TIA on antiplatelet therapy.
- Published
- 2018
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