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  • Hart, Robert G.Hamilton Health Sciences (författare)

Predictors of Recurrent Ischemic Stroke in Patients with Embolic Strokes of Undetermined Source and Effects of Rivaroxaban Versus Aspirin According to Risk Status : The NAVIGATE ESUS Trial

  • Artikel/kapitelEngelska2019

Förlag, utgivningsår, omfång ...

  • Elsevier BV,2019

Nummerbeteckningar

  • LIBRIS-ID:oai:lup.lub.lu.se:e5eedff4-8ad5-45c0-b00e-34760b6e3dcf
  • https://lup.lub.lu.se/record/e5eedff4-8ad5-45c0-b00e-34760b6e3dcfURI
  • https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.05.014DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:art swepub-publicationtype
  • Ämneskategori:ref swepub-contenttype

Anmärkningar

  • Background: Embolic stroke of undetermined source (ESUS) identifies patients with cryptogenic ischemic stroke presumed due to embolism from several unidentified sources. Among patients with recent ESUS, we sought to determine independent predictors of recurrent ischemic stroke during treatment with aspirin or rivaroxaban and to assess the relative effects of these treatments according to risk. Methods: Exploratory analyses of 7213 participants in the NAVIGATE ESUS international trial who were randomized to aspirin 100 mg/day or rivaroxaban 15 mg/day and followed for a median of 11 months, during which time there were 309 first recurrent ischemic strokes (4.6% per year). Baseline features were correlated with recurrent stroke by multivariate analysis. Results: The 7 independent predictors of recurrent stroke were stroke or transient ischemic attack (TIA) prior to the qualifying stroke (hazard ratio [HR] 2.03 95% confidence internal [CI] 1.58-2.60), current tobacco user (HR 1.62, 95% CI 1.24-2.12), age (HR 1.02 per year increase, 95%CI 1.01-1.03), diabetes (HR 1.28, 95% CI 1.01-1.64), multiple acute infarcts on neuroimaging (HR 1.49, 95% CI 1.09-2.02), aspirin use prior to qualifying stroke (HR 1.34, 95% CI 1.02-1.70), and time from qualifying stroke to randomization (HR .98, 95% CI .97-.99). The rate of recurrent stroke rate was 2.6% per year for participants without any of these risk factors, and increased by an average of 45% for each independent predictor (P < .001). There were no significant interactions between treatment effects and independent stroke predictors or stroke risk status. Conclusions: In this large cohort of ESUS patients, several features including prior stroke or TIA, advanced age, current tobacco user, multiple acute infarcts on neuroimaging, and diabetes independently identified those with an increased risk of ischemic stroke recurrence. The relative effects of rivaroxaban and aspirin were similar across the spectrum of independent stroke predictors and recurrent stroke risk status.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Veltkamp, Roland C.Imperial College London (författare)
  • Sheridan, PatrickHamilton Health Sciences (författare)
  • Sharma, MukulPopulation Health Research Institute, Ontario,McMaster University (författare)
  • Kasner, Scott E.University of Pennsylvania (författare)
  • Bangdiwala, Shrikant I.McMaster University,Population Health Research Institute, Ontario (författare)
  • Ntaios, GeorgeUniversity of Thessaly (författare)
  • Shoamanesh, AshkanMcMaster University,Population Health Research Institute, Ontario (författare)
  • Ameriso, Sebastian F.Fundacion Para La Lucha Contra Las Enfermedades Neurologicas de La Infancia (FLENI) (författare)
  • Toni, DaniloSapienza University of Rome (författare)
  • Czlonkowska, AnnaMedical University of Warsaw (författare)
  • Lindgren, ArneLund University,Lunds universitet,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Clinical Stroke Research Group,Lund University Research Groups,Skåne University Hospital(Swepub:lu)neur-ali (författare)
  • Hankey, Graeme J.Sir Charles Gairdner Hospital,University of Western Australia, Crawley (författare)
  • Perera, Kanjana S.Population Health Research Institute, Ontario,McMaster University (författare)
  • Shuaib, AshfaqUniversity of Alberta Hospital (författare)
  • Coutts, Shelagh B.Hotchkiss Brain Institute (författare)
  • Gagliardi, Rubens J.Irmandade da Santa Casa de Misericordia de Sao Paulo (författare)
  • Berkowitz, Scott D.Bayer Corporation, USA (författare)
  • Mundl, HardiBayer Pharma AG (författare)
  • Peters, GaryJanssen Pharmaceuticals, US (författare)
  • Connolly, Stuart J.Population Health Research Institute, Ontario,McMaster University (författare)
  • Hamilton Health SciencesImperial College London (creator_code:org_t)
  • NAVIGATE ESUS Investigators

Sammanhörande titlar

  • Ingår i:Journal of Stroke and Cerebrovascular Diseases: Elsevier BV28:8, s. 2273-22791052-3057

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