Antiplatelet Therapy for Secondary Prevention in Patients with Ischaemic Stroke and Transient Ischaemic Attack: A Retrospective Cohort Study in Malaysia
Antiplatelet Therapy for Stroke Secondary Prevention
Abstract
In this study, we evaluated clinical outcomes of antiplatelet therapy for secondary prevention in ischaemic stroke and transient ischaemic attack (TIA) patients. This was a retrospective cohort study that included patients with newly diagnosed ischaemic stroke or TIA between 2014 and 2017 using data from routine practice in Malaysia. Patients were grouped into single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) users. Primary outcome was composite of stroke, myocardial infarction, and all-cause death in 90 days and 1 year. Safety outcome was major bleeding events. Among 3344 stroke patients, 8.1% received DAPT and 91.2% received SAPT. The 1-year cumulative incidence of composite events was 16.0 and 7.2 per 100 person-years for SAPT and DAPT, respectively. Propensity score-matched analysis of Cox hazard model showed DAPT reduced the risk of composite event (hazard ratio (HR) 0.48; 95% CI 0.25-0.91) and recurrent stroke (HR 0.38; 95% CI 0.16-0.92) in 1-year follow-up. Results were not significant for myocardial infarction, all-cause death, and 90-day outcomes. The risks of bleeding were not significantly different between SAPT and DAPT. Treatment with DAPT after an ischaemic stroke/TIA was associated with reduced risk of the composite events (stroke, myocardial infarction, or death) and recurrent stroke at 1 year.
Keywords :
Antiplatelet; secondary prevention; stroke,
Abstrak
Dalam kajian ini, kami menilai hasil klinikal terapi antiplatelet untuk pencegahan sekunder berikutan diagnosis strok iskemia atau serangan iskemia sementara (TIA). Ini adalah kajian kohort retrospektif yang merangkumi pesakit dewasa dengan strok iskemia atau TIA yang baru didiagnosis antara tahun 2014 dan 2017 dengan menggunakan data daripada pangkalan data di Malaysia. Pesakit dikategorikan kepada pengguna terapi antiplatelet tunggal (SAPT) dan terapi dwi antiplatelet (DAPT). Hasil utama adalah gabungan strok, infarksi miokardium dan kematian semua sebab dalam tempoh 90 hari dan 1 tahun. Hasil keselamatan adalah pendarahan. Di antara 3344 pesakit strok, 8.1% menerima DAPT dan 91.2% menerima SAPT. Insiden terkumpul satu tahun bagi peristiwa komposit ialah 16.0 dan 7.2 masing-masing bagi setiap 100 orang-tahun untuk SAPT dan DAPT. Analisis padanan skor kecenderungan model bahaya Cox menunjukkan DAPT mengurangkan risiko kejadian komposit (nisbah bahaya (HR) 0.48; 95% CI 0.25-0.91) dan strok berulang (HR 0.38; 95% CI 0.16-0.92). Keputusan adalah tidak signifikan untuk hasil individu lain dan hasil 90 hari. Risiko pendarahan tidak jauh berbeza antara SAPT dan DAPT. Rawatan dengan DAPT selepas strok iskemia/TIA dikaitkan dengan pengurangan risiko kejadian komposit (strok, infarksi miokardium atau kematian) dan strok berulang dalam tempoh 1 tahun.
Kata Kunci :
Antiplatelet; pencegahan sekunder; strok,
Correspondance Address
Norazida Ab Rahman. Block B4, Institute for Clinical Research National Institutes of Health (NIH), Ministry of Health Malaysia No 1, Jalan Setia Murni U13/52
40170 Shah Alam, Selangor, Malaysia. Tel: +603-3362 8824 Email: norazida@crc.gov.my
