Comparative Effectiveness of Prestroke Aspirin on Stroke Severity and Outcome

Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods Using a multicenter stroke registry database, patients with acute ischemic stroke of three subtypes (large artery atherosclerosis [LAA], smal...

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Published inAnnals of neurology Vol. 79; no. 4; pp. 560 - 568
Main Authors Park, Jong-Moo, Kang, Kyusik, Cho, Yong-Jin, Hong, Keun-Sik, Lee, Kyung Bok, Park, Tai Hwan, Lee, Soo Joo, Ko, Youngchai, Han, Moon-Ku, Lee, Jun, Cha, Jae-Kwan, Kim, Dae-Hyun, Kim, Dong-Eog, Kim, Joon-Tae, Choi, Jay Chol, Yu, Kyung-Ho, Lee, Byung-Chul, Lee, Ji Sung, Lee, Juneyoung, Gorelick, Philip B., Bae, Hee-Joon
Format Journal Article
LanguageEnglish
Published United States Blackwell Publishing Ltd 01.04.2016
Wiley Subscription Services, Inc
John Wiley and Sons Inc
Subjects
Aged
Aged, 80 and over
Aspirin
Aspirin - adverse effects
Aspirin - pharmacology
Brain Ischemia - epidemiology
Brain Ischemia - prevention & control
Brain Ischemia - therapy
Confidence intervals
Female
Health risk assessment
Hemorrhage
Humans
Intracranial Hemorrhages - chemically induced
Intracranial Hemorrhages - epidemiology
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Platelet Aggregation Inhibitors - adverse effects
Platelet Aggregation Inhibitors - pharmacology
Registries - statistics & numerical data
Retrospective Studies
Severity of Illness Index
Stroke
Stroke - epidemiology
Stroke - prevention & control
Stroke - therapy
Online AccessGet full text
ISSN0364-5134
1531-8249
DOI10.1002/ana.24602

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Abstract Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods Using a multicenter stroke registry database, patients with acute ischemic stroke of three subtypes (large artery atherosclerosis [LAA], small vessel occlusion [SVO], or cardioembolism [CE]) were identified. NIH stroke scale (NIHSS) and hemorrhagic transformation at presentation and discharge modified Rankin Scale (mRS) were compared between prestroke aspirin users and nonusers. Results Among the 10,433 patients, 1,914 (18.3%) reported prestroke aspirin use. On crude analysis, initial NIHSS scores of aspirin users were higher than nonusers (mean difference: 0.35; 95% confidence interval [CI]: 0.04–0.66). However, a multivariable analysis with an application of inverse probability of treatment weighting based on a propensity score of prestroke aspirin, having an interaction effect of prestroke aspirin use and stroke subtype in the model, showed less stroke severity for aspirin users in LAA, but not in SVO and CE than for nonusers; mean difference in NIHSS scores in LAA was –0.97 (95% CI: –1.45 to –0.49). With respect to hemorrhagic transformation and mRS, no significant interaction effects were found. Prestroke aspirin use increased the risk of hemorrhagic transformation (adjusted odd ratio: 1.34; 95% CI: 1.05–1.73), but decreased the odds of the higher discharge mRS (0.86; 0.76–0.96). Interpretation Prestroke aspirin use may reduce initial stroke severity in atherothrombotic stroke and can improve functional outcome at discharge despite an increase of hemorrhagic transformation irrespective of stroke subtype. Ann Neurol 2016;79:560–568
AbstractList Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods Using a multicenter stroke registry database, patients with acute ischemic stroke of three subtypes (large artery atherosclerosis [LAA], small vessel occlusion [SVO], or cardioembolism [CE]) were identified. NIH stroke scale (NIHSS) and hemorrhagic transformation at presentation and discharge modified Rankin Scale (mRS) were compared between prestroke aspirin users and nonusers. Results Among the 10,433 patients, 1,914 (18.3%) reported prestroke aspirin use. On crude analysis, initial NIHSS scores of aspirin users were higher than nonusers (mean difference: 0.35; 95% confidence interval [CI]: 0.04-0.66). However, a multivariable analysis with an application of inverse probability of treatment weighting based on a propensity score of prestroke aspirin, having an interaction effect of prestroke aspirin use and stroke subtype in the model, showed less stroke severity for aspirin users in LAA, but not in SVO and CE than for nonusers; mean difference in NIHSS scores in LAA was -0.97 (95% CI: -1.45 to -0.49). With respect to hemorrhagic transformation and mRS, no significant interaction effects were found. Prestroke aspirin use increased the risk of hemorrhagic transformation (adjusted odd ratio: 1.34; 95% CI: 1.05-1.73), but decreased the odds of the higher discharge mRS (0.86; 0.76-0.96). Interpretation Prestroke aspirin use may reduce initial stroke severity in atherothrombotic stroke and can improve functional outcome at discharge despite an increase of hemorrhagic transformation irrespective of stroke subtype. Ann Neurol 2016;79:560-568
Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods Using a multicenter stroke registry database, patients with acute ischemic stroke of three subtypes (large artery atherosclerosis [LAA], small vessel occlusion [SVO], or cardioembolism [CE]) were identified. NIH stroke scale (NIHSS) and hemorrhagic transformation at presentation and discharge modified Rankin Scale (mRS) were compared between prestroke aspirin users and nonusers. Results Among the 10,433 patients, 1,914 (18.3%) reported prestroke aspirin use. On crude analysis, initial NIHSS scores of aspirin users were higher than nonusers (mean difference: 0.35; 95% confidence interval [CI]: 0.04–0.66). However, a multivariable analysis with an application of inverse probability of treatment weighting based on a propensity score of prestroke aspirin, having an interaction effect of prestroke aspirin use and stroke subtype in the model, showed less stroke severity for aspirin users in LAA, but not in SVO and CE than for nonusers; mean difference in NIHSS scores in LAA was –0.97 (95% CI: –1.45 to –0.49). With respect to hemorrhagic transformation and mRS, no significant interaction effects were found. Prestroke aspirin use increased the risk of hemorrhagic transformation (adjusted odd ratio: 1.34; 95% CI: 1.05–1.73), but decreased the odds of the higher discharge mRS (0.86; 0.76–0.96). Interpretation Prestroke aspirin use may reduce initial stroke severity in atherothrombotic stroke and can improve functional outcome at discharge despite an increase of hemorrhagic transformation irrespective of stroke subtype. Ann Neurol 2016;79:560–568
The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Using a multicenter stroke registry database, patients with acute ischemic stroke of three subtypes (large artery atherosclerosis [LAA], small vessel occlusion [SVO], or cardioembolism [CE]) were identified. NIH stroke scale (NIHSS) and hemorrhagic transformation at presentation and discharge modified Rankin Scale (mRS) were compared between prestroke aspirin users and nonusers. Among the 10,433 patients, 1,914 (18.3%) reported prestroke aspirin use. On crude analysis, initial NIHSS scores of aspirin users were higher than nonusers (mean difference: 0.35; 95% confidence interval [CI]: 0.04-0.66). However, a multivariable analysis with an application of inverse probability of treatment weighting based on a propensity score of prestroke aspirin, having an interaction effect of prestroke aspirin use and stroke subtype in the model, showed less stroke severity for aspirin users in LAA, but not in SVO and CE than for nonusers; mean difference in NIHSS scores in LAA was -0.97 (95% CI: -1.45 to -0.49). With respect to hemorrhagic transformation and mRS, no significant interaction effects were found. Prestroke aspirin use increased the risk of hemorrhagic transformation (adjusted odd ratio: 1.34; 95% CI: 1.05-1.73), but decreased the odds of the higher discharge mRS (0.86; 0.76-0.96). Prestroke aspirin use may reduce initial stroke severity in atherothrombotic stroke and can improve functional outcome at discharge despite an increase of hemorrhagic transformation irrespective of stroke subtype.
Author Hong, Keun-Sik
Lee, Jun
Yu, Kyung-Ho
Gorelick, Philip B.
Lee, Byung-Chul
Lee, Ji Sung
Han, Moon-Ku
Bae, Hee-Joon
Lee, Juneyoung
Park, Jong-Moo
Lee, Soo Joo
Choi, Jay Chol
Kang, Kyusik
Cho, Yong-Jin
Kim, Dong-Eog
Ko, Youngchai
Kim, Joon-Tae
Park, Tai Hwan
Cha, Jae-Kwan
Kim, Dae-Hyun
Lee, Kyung Bok
AuthorAffiliation 9 Dongguk University Ilsan Hospital Goyang
3 Soonchunhyang University Hospital Seoul
10 Chonnam National University Hospital Gwangju
11 Jeju National University Hospital Jeju
13 Clinical Research Center, Asan Medical Center Seoul
14 Department of Biostatistics Korea University College of Medicine Seoul
1 Departments of Neurology Eulji, General Hospital, Eulji University Seoul
5 Eulji University Hospital Daejeon
12 Hallym University College of Medicine Pyeongchon
15 Department of Translational Science and Molecular Medicine Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences Grand Rapids MI
2 Ilsan Paik Hospital, Inje University College of Medicine Goyang
7 Yeungnam University Hospital Daegu
8 Dong‐A University Hospital Busan
6 Seoul National University Bundang Hospital Seongnam
4 Seoul Medical Center Seoul
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  organization: Yeungnam University Hospital, Daegu
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  surname: Kim
  fullname: Kim, Dae-Hyun
  organization: Dong-A University Hospital, Busan
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  fullname: Kim, Dong-Eog
  organization: Dongguk University Ilsan Hospital, Goyang
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  givenname: Joon-Tae
  surname: Kim
  fullname: Kim, Joon-Tae
  organization: Chonnam National University Hospital, Gwangju
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  givenname: Jay Chol
  surname: Choi
  fullname: Choi, Jay Chol
  organization: Jeju National University Hospital, Jeju
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  surname: Bae
  fullname: Bae, Hee-Joon
  email: braindoc@snu.ac.kr
  organization: Seoul National University Bundang Hospital, Seongnam
BackLink https://www.ncbi.nlm.nih.gov/pubmed/26754410$$D View this record in MEDLINE/PubMed
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DocumentTitleAlternate Effect of Previous Aspirin Use on Stroke
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2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.
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1993; 24
2007; 146
2015; 17
1989; 20
2013; 44
2006; 37
1977; 40
2006; 5
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1992; 108
2006
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1983; 70
2012; 367
2008; 264
2014; 130
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1979; 10
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2010; 41
2013; 9
2007; 357
1997; 50
1995; 26
2010; 29
2006; 66
2000; 11
2006; 25
2011; 42
2014; 16
1996; 274
2011; 123
2012; 43
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References_xml – reference: Ko Y, Lee S, Chung JW, et al. MRI-based algorithm for acute ischemic stroke subtype classification. J Stroke 2014;16:161-172.
– reference: Kim WJ, Ko Y, Yang MH, et al. Differential effect of previous antiplatelet use on stroke severity according to stroke mechanism. Stroke 2010;41:1200-1204.
– reference: Ricci S, Lewis S, Sandercock P, et al. Previous use of aspirin and baseline stroke severity: an analysis of 17 850 patients in the International Stroke Trial. Stroke 2006;37:1737-1740.
– reference: Hernan MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology 2000;11:561-570.
– reference: Riepe MW, Kasischke K, Raupach A. Acetylsalicylic acid increases tolerance against hypoxic and chemical hypoxia. Stroke 1997;28:2006-2011.
– reference: Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology 2000;11:550-560.
– reference: O'Donnell M, Oczkowski W, Fang J, et al. Preadmission antithrombotic treatment and stroke severity in patients with atrial fibrillation and acute ischaemic stroke: an observational study. Lancet Neurol. 2006;5:749-754.
– reference: Sanossian N, Saver JL, Rajajee V, et al. Premorbid antiplatelet use and ischemic stroke outcomes. Neurology 2006;66(3):319-323.
– reference: Austin PC, Mamdani MM. A comparison of propensity score methods: a case-study estimating the effectiveness of post-AMI statin use. Stat Med 2006;25:2084-2106.
– reference: Katz MH. Multivariable Analysis: A Practical Guide for Clinicians, 2nd ed. Cambridge, UK: Cambridge University Press; 2006.
– reference: Grotta JC, Lemak NA, Gary H, et al. Does platelet antiaggregant therapy lessen the severity of stroke? Neurology 1985;35:632-636.
– reference: Kwok CS, Skinner J, Metcalf AK, et al. Prior antiplatelet or anticoagulant therapy and mortality in stroke. Heart 2012;98:712-717.
– reference: Paciaroni M, Agnelli G, Caso V, et al. Prior use of antithrombotic agents and neurological functional outcome at discharge in patients with ischemic stroke. J Thromb Haemost 2006;4:1957-1961.
– reference: Scott SC, Goldberg MS, Mayo NE. Statistical assessment of ordinal outcomes in comparative studies. J Clin Epidemiol 1997;50:45-55.
– reference: Grilli M, Pizzi M, Memo M, et al. Neuroprotection by aspirin and sodium salicylate through blockade of NF-κB activation. Science 1996;274:1383-1385.
– reference: Kuhn W, Muller T, Bttner T, et al. Aspirin as a free radical scavenger: consequences for therapy of cerebrovascular ischemia. Stroke 1995;26:1959-1960.
– reference: Kim BJ, Han MK, Park TH, et al. Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry. Int J Stroke 2013;9:514-518.
– reference: Shuaib A, Lees KR, Lyden P, et al. NXY-059 for the treatment of acute ischemic stroke. N Engl J Med 2007;357:562-571.
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– reference: Brookhart MA, Wyss R, Layton JB, et al. Propensity score methods for confounding control in nonexperimental research. Circ Cardiovasc Qual Outcomes 2013;6:604-611.
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– reference: Joseph R, D'Andrea G, Oster SB, et al. Whole blood platelet function in acute ischemic stroke. Importance of dense body secretion and effects of antithrombotic agents. Stroke 1989;20:38-44.
– reference: Rosenblum WI, El-Sabban F. Platelet aggregation in the cerebral microcirculation: effect of aspirin and other agents. Circ Res 1977;40:320-328.
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– reference: Lees KR, Bath PMW, Schellinger PD, et al. Contemporary outcome measures in acute stroke research: choice of primary outcome measure. Stroke 2012;43:1163-1170.
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Snippet Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods...
The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Using a...
Objective The effect of prestroke aspirin use on initial severity, hemorrhagic transformation, and functional outcome of ischemic stroke is uncertain. Methods...
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StartPage 560
SubjectTerms Aged
Aged, 80 and over
Aspirin
Aspirin - adverse effects
Aspirin - pharmacology
Brain Ischemia - epidemiology
Brain Ischemia - prevention & control
Brain Ischemia - therapy
Confidence intervals
Female
Health risk assessment
Hemorrhage
Humans
Intracranial Hemorrhages - chemically induced
Intracranial Hemorrhages - epidemiology
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Platelet Aggregation Inhibitors - adverse effects
Platelet Aggregation Inhibitors - pharmacology
Registries - statistics & numerical data
Retrospective Studies
Severity of Illness Index
Stroke
Stroke - epidemiology
Stroke - prevention & control
Stroke - therapy
Title Comparative Effectiveness of Prestroke Aspirin on Stroke Severity and Outcome
URI https://api.istex.fr/ark:/67375/WNG-C349XGTF-0/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fana.24602
https://www.ncbi.nlm.nih.gov/pubmed/26754410
https://www.proquest.com/docview/1779687188
https://www.proquest.com/docview/1785240863
https://pubmed.ncbi.nlm.nih.gov/PMC5067647
Volume 79
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