Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial : Recurrent stroke risk and response to antithrombotic therapy
Copyright © 2020. Published by Elsevier Inc..
BACKGROUND: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis.
METHODS: Exploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed.
RESULTS: Among 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5).
CONCLUSIONS: East Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
|---|---|
| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 29(2020), 8 vom: 18. Aug., Seite 104936 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ameriso, Sebastian F [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 30.10.2020 Date Revised 30.10.2020 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jstrokecerebrovasdis.2020.104936 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM312659075 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM312659075 | ||
| 003 | DE-627 | ||
| 005 | 20231225144904.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jstrokecerebrovasdis.2020.104936 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1042.xml |
| 035 | |a (DE-627)NLM312659075 | ||
| 035 | |a (NLM)32689594 | ||
| 035 | |a (PII)S1052-3057(20)30342-6 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ameriso, Sebastian F |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial |b Recurrent stroke risk and response to antithrombotic therapy |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 30.10.2020 | ||
| 500 | |a Date Revised 30.10.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020. Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis | ||
| 520 | |a METHODS: Exploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed | ||
| 520 | |a RESULTS: Among 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5) | ||
| 520 | |a CONCLUSIONS: East Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis | ||
| 650 | 4 | |a Clinical Trial, Phase III | |
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Cerebrovascular atherosclerosis | |
| 650 | 4 | |a ESUS | |
| 650 | 4 | |a Embolic stroke | |
| 650 | 4 | |a Intracranial atherosclerosis | |
| 650 | 4 | |a Randomized trial | |
| 650 | 4 | |a Rivaroxaban | |
| 650 | 7 | |a Factor Xa Inhibitors |2 NLM | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 650 | 7 | |a Platelet Aggregation Inhibitors |2 NLM | |
| 650 | 7 | |a Rivaroxaban |2 NLM | |
| 650 | 7 | |a 9NDF7JZ4M3 |2 NLM | |
| 650 | 7 | |a Aspirin |2 NLM | |
| 650 | 7 | |a R16CO5Y76E |2 NLM | |
| 700 | 1 | |a Amarenco, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Pearce, Lesly A |e verfasserin |4 aut | |
| 700 | 1 | |a Perera, Kanjana S |e verfasserin |4 aut | |
| 700 | 1 | |a Ntaios, George |e verfasserin |4 aut | |
| 700 | 1 | |a Lang, Wilfried |e verfasserin |4 aut | |
| 700 | 1 | |a Bereczki, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Uchiyama, Shinichiro |e verfasserin |4 aut | |
| 700 | 1 | |a Kasner, Scott E |e verfasserin |4 aut | |
| 700 | 1 | |a Yoon, Byung-Woo |e verfasserin |4 aut | |
| 700 | 1 | |a Lavados, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Firstenfeld, Alfredo |e verfasserin |4 aut | |
| 700 | 1 | |a Mikulik, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Povedano, Guillermo Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Jorge |e verfasserin |4 aut | |
| 700 | 1 | |a Mundl, Hardi |e verfasserin |4 aut | |
| 700 | 1 | |a Berkowitz, Scott D |e verfasserin |4 aut | |
| 700 | 1 | |a Connolly, Stuart J |e verfasserin |4 aut | |
| 700 | 1 | |a Hart, Robert G |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association |d 1991 |g 29(2020), 8 vom: 18. Aug., Seite 104936 |w (DE-627)NLM090676726 |x 1532-8511 |7 nnns |
| 773 | 1 | 8 | |g volume:29 |g year:2020 |g number:8 |g day:18 |g month:08 |g pages:104936 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 29 |j 2020 |e 8 |b 18 |c 08 |h 104936 | ||