Back to Search
Start Over
Bleeding Risk of Dual Antiplatelet Therapy after Minor Stroke or Transient Ischemic Attack.
- Source :
-
Annals of neurology [Ann Neurol] 2022 Mar; Vol. 91 (3), pp. 380-388. Date of Electronic Publication: 2022 Jan 10. - Publication Year :
- 2022
-
Abstract
- Objective: This study was undertaken to identify the risk of bleeding events and potential risk factors within 90 days in patients who carried CYP2C19 loss-of-function alleles and received dual antiplatelet therapy after minor stroke or transient ischemic attack.<br />Methods: A total of 6,412 patients were enrolled from the CHANCE-2 (Clopidogrel with Aspirin in High-Risk Patients with Acute Non-disabling Cerebrovascular Events II) trial. The main outcome was any bleeding within 90 days defined by the criteria from GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries).<br />Results: A total of 250 (3.9%) bleeding events were reported, which occurred mainly within the 21 days of dual antiplatelet therapy (200 cases, 3.1%). Minor bleeding of the skin bruises, epistaxis, and gum bleeding were most frequent. Multivariate analysis showed that treatment with ticagrelor-aspirin compared with clopidogrel-aspirin was associated with increased bleeding (hazard ratio [HR] = 2.21, 95% confidence interval [CI] = 1.68-2.89, p < 0.001). Current smoking was associated with a lower risk of bleeding (HR = 0.70, 95% CI = 0.52-0.95, p = 0.02). Additionally, ticagrelor-aspirin compared with clopidogrel-aspirin was associated with higher risk of bleeding in patients aged <65 years (HR = 2.87, 95% CI = 1.95-4.22) and those without diabetes mellitus (HR = 2.65, 95% CI = 1.88-3.73; p for interaction = 0.04 and 0.03, respectively).<br />Interpretation: Bleeding events mostly occurred within the 21-day dual antiplatelet therapy stage and were generally mild. The risk of bleeding was greater in nonsmoking patients, and was associated with treatment with ticagrelor-aspirin compared with clopidogrel-aspirin, particularly in patients aged <65 years and nondiabetic patients. ANN NEUROL 2022;91:380-388.<br /> (© 2021 American Neurological Association.)
- Subjects :
- Aged
Alleles
Aspirin therapeutic use
Clopidogrel therapeutic use
Drug Therapy, Combination
Female
Genetic Predisposition to Disease
Humans
Ischemic Attack, Transient genetics
Ischemic Stroke genetics
Male
Middle Aged
Platelet Aggregation Inhibitors therapeutic use
Risk Factors
Treatment Outcome
Aspirin adverse effects
Clopidogrel adverse effects
Cytochrome P-450 CYP2C19 genetics
Hemorrhage chemically induced
Ischemic Attack, Transient drug therapy
Ischemic Stroke drug therapy
Platelet Aggregation Inhibitors adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1531-8249
- Volume :
- 91
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Annals of neurology
- Publication Type :
- Academic Journal
- Accession number :
- 34951042
- Full Text :
- https://doi.org/10.1002/ana.26287