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Eur J Neurol. 2019 Nov 6. doi: 10.1111/ene.14116. [Epub ahead of print]

Antiplatelet agents on the secondary prevention of ischemic stroke in patients with or without renal dysfunction.

Author information

1
Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
2
Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
3
Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
4
Chang Gung University College of Medicine, Taoyuan, Taiwan.
5
Departmemt of Neurology, China Medical University Hospital, Taichung, Taiwan.
6
Department of Neurology, En Chu Kong Hospital, Taipei, Taiwan.
7
Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
8
Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
9
Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan.
10
Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
11
Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
12
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
13
Department of Health Services Administration, China Medical University College of Public Health, Taichung, 404, Taiwan.
14
Graduate Institute of Clinical Science, College of Medicine, China Medical University.

Abstract

BACKGROUND AND PURPOSE:

Studies on using antiplatelet agents for secondary prevention in ischemic stroke patients with renal dysfunction are limited. We used the Taiwan Stroke Registry (TSR) database to compare the efficacy of antiplatelet agents.

METHODS:

From the TSR data, we identified 39174 acute ischemic stroke patients and classified them into three groups by the antiplatelet agent: aspirin, clopidogrel, and dual antiplatelet therapy (DAPT) with the combination of aspirin and clopidogrel. The re-stroke incidence and one-year mortality were stratified by estimated glomerular filtration rate (eGFR) levels at admission: ≥ 90, 60-89, and <60 mL/min/1.73m2 or on dialysis.

RESULTS:

Compared to the aspirin group, the re-stroke differences were not statistically significant for the clopidogrel group (adjusted subhazard ratio (aSHR) = 0.95, 95% CI: 0.84-1.08) and the DAPT group (aSHR=1.03, 95% CI: 0.77-1.39) after controlling for the competing risk of deaths. The mortality rate increased as the eGFR level declined. In addition, compared to patients taking aspirin, there was no statistically significant difference in overall one-year mortality for the clopidogrel group (adjusted hazard ratio (aHR): 1.11, 95% CI: 0.95-1.29) and for the DAPT group (aHR: 1.01, 95% CI: 0.67-1.54). The results were consistent in different subgroups stratified by eGFR levels.

CONCLUSIONS:

There was no difference in the risks of recurrent stroke and one-year mortality among ischemic stroke patients with or without renal dysfunction receiving antiplatelet agents with aspirin, clopidogrel or dual agents with the combination of aspirin and clopidogrel, regardless of their renal dysfunction status.

KEYWORDS:

aspirin; clopidogrel; estimated glomerular filtration rate; ischemic stroke; renal function; secondary prevention

PMID:
31693249
DOI:
10.1111/ene.14116

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