Comparison of Antiplatelet Therapies for Prevention of Patent Foramen Ovale-Associated Stroke |
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| Institution: | 2. WL Gore and Associates, Flagstaff, Arizona;3. Aarhus University, Aarhus, Denmark;4. University of Copenhagen, Copenhagen, Denmark;6. Turku University Hospital and University of Turku, Turku, Finland;5. Karolinska Instituet, Stockholm, Sweden;11. Rigshospitalet, Copenhagen, Denmark;2. Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China;2. Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal;3. Department of Clinical Haematology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal;2. The Warren Alpert Medical School of Brown University, Department of Neurosurgery, Providence, Rhode Island;3. The Warren Alpert Medical School of Brown University, Department of Radiology, Providence, Rhode Island;5. Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York;4. The Warren Alpert Medical School of Brown University, Department of Internal Medicine, Division of Cardiovascular Medicine, Providence, Rhode Island;2. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan;2. Graduate School of Health Sciences, Sapporo Medical University, Hokkaido, Japan;3. Rehabilitation Center, Fujioka General Hospital, Gunma, Japan;4. Department of Rehabilitation Technique, Ageo Central General Hospital, Saitama, Japan;5. Department of Physical Therapy, School of Health and Social Science, Saitama Prefectural University, Saitama, Japan;2. Comprehensive Stroke Center, Department of Neurology, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czech Republic;3. Department of Radiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic;4. Department of Radiology, Masaryk Hospital Ústí nad Labem KZ a.s. and Faculty of Health Studies, J.E. Purkinje University, Ústí nad Labem, Czech Republic;5. Department of Medical Biophysics and Statistics, Palacký University Medical School, Olomouc, Czech Republic;6. Department of Emergency, Masaryk Hospital Ústí nad Labem KZ a.s., Ústí nad Labem, Czech Republic |
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| Abstract: | AimsThe REDUCE study demonstrated a reduction in the risk of recurrent stroke with patent foramen ovale closure and antiplatelet therapy compared to antiplatelet therapy alone. The clinicians were allowed to choose among aspirin, clopidogrel, or aspirin/dipyridamole with the expectation that all antiplatelet therapies would have similar efficacy in this population. We tested that presumption by comparing recurrent stroke rates among antiplatelet agents within the control arm of the trial.MethodsWe evaluated patients in REDUCE study who were randomized to the medical arm. The primary endpoint for this analysis was freedom from clinical ischemic stroke through at least 2 years of follow-up, to a maximum of 5 years. In the primary analysis, antiplatelet treatment was defined as the agent during the week prior to a recurrent stroke or last known contact.ResultsOf 223 patients in the medical treatment arm, the initial agent was aspirin 52%, clopidogrel 30%, and aspirin/dipyridamole 12%. Patients treated with aspirin were similar to those treated with alternatives, but were more likely to be enrolled in the United States. The last reported agent was aspirin alone in 55%, clopidogrel alone in 31%, aspirin/dipyridamole in 7%, and other/nothing/missing in 7%. Recurrent stroke rates were similar for all 3 antiplatelet regimens in unadjusted and adjusted analyses, with no overall difference among agents (P= .17).ConclusionsAmong patients with patent foramen ovale-associated stroke who were managed medically, there were no differences among antiplatelet agents in the risk of recurrent stroke, though confidence intervals were wide. |
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