Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin.

Kim, Joon-Tae; Kim, Beom Joon; Park, Jong-Moo; Lee, Soo Joo; Cha, Jae-Kwan; Park, Tai Hwan; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Lee, Byung-Chul; Kim, Dong-Eog; Choi, Jay Chol; Kwon, Jee-Hyun; Shin, Dong-Ick; Sohn, Sung Il; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon

Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

DISEASE relapse; PLATELET aggregation inhibitors; CLOPIDOGREL; STROKE treatment; ASPIRIN

Scientific Reports, 2020, Vol 10, Issue 1, pN.PAG

2045-2322

Academic Journal

10.1038/s41598-020-73836-0