Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke

Alexandros L. Georgiadis; Steve M. Cordina; Gabriela Vazquez; Nauman Tariq; M. Fareed K. Suri; Kamakshi Lakshminarayan; Harold P. Adams; Adnan I. Qureshi

doi:10.1016/j.jstrokecerebrovasdis.2011.06.017

Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke

Alexandros L. Georgiadis, Steve M. Cordina, Gabriela Vazquez, Nauman Tariq, M. Fareed K. Suri, Kamakshi Lakshminarayan, Harold P. Adams, Adnan I. Qureshi

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: The prognostic value of occurrence of ischemic stroke in a patient despite aspirin treatment (aspirin treatment failure) is not known. Our objective was to determine if aspirin treatment failure predicts recurrent ischemic stroke and/or death. Methods: We performed a post-hoc analysis of data from the National Institute of Neurological Disorders and Stroke (NINDS) intravenous recombinant tissue plasminogen activator (rt-PA) trial and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). Multivariate analysis was used to calculate the odds ratio (OR) of recurrent stroke and recurrent stroke or death for aspirin treatment failure patients for the duration of available follow-up (3 months for TOAST patients; 12 months for NINDS rt-PA trial patients). Results: The rate of aspirin treatment failure was 40% and 35% among 1275 patients and 624 patients recruited in the TOAST and NINDS rt-PA trials, respectively. The risk of stroke and death at 3 months and 1 year was not higher among patients classified as aspirin treatment failures among the TOAST (OR 1.1; 95% confidence interval [CI] 0.8-1.6; P =.7) or NINDS rt-PA trial patients (OR 0.8; 95% CI 0.6-1.3; P =.4), respectively. In subgroup analysis, aspirin treatment failure was not found to be associated with recurrent stroke or with the combined endpoint of stroke and death among categories defined by etiologic subtype, including those with large artery atherosclerosis. Conclusions: In a post-hoc analysis of 2 randomized ischemic stroke trials, aspirin treatment failure was not found to be associated with an increased risk of recurrent stroke or death.

Original language	English (US)
Pages (from-to)	100-106
Number of pages	7
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	22
Issue number	2
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.06.017
State	Published - Feb 2013

Bibliographical note

Funding Information:
Dr. Lakshminarayan is on the adverse events committee for CVRx and AGA Medical, both device manufacturers. She is funded by National Institutes of Health Grant K23NS051377 , is a coinvestigator for the Centers for Disease Control and Prevention Grant U58DP000857 , and received support from an American Academy of Neurology fellowship ( #84500-2002 ). Dr. Adams has received financial support from NMT Medical, Schering-Plough, Medtronic, and Merck . Dr. Qureshi has received funding from National Institutes of Health RO-1-NS44976-01A2 (medication provided by ESP Pharma), the American Heart Association Established Investigator Award 0840053N , and the Minnesota Medical Foundation , Minneapolis, MN. Drs. Georgiadis, Cordina, Vazquez, Tariq, and Suri have no conflicts of interest to disclose.

Keywords

Aspirin resistance
aspirin treatment failure
ischemic stroke

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10.1016/j.jstrokecerebrovasdis.2011.06.017

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title = "Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke",

abstract = "Background: The prognostic value of occurrence of ischemic stroke in a patient despite aspirin treatment (aspirin treatment failure) is not known. Our objective was to determine if aspirin treatment failure predicts recurrent ischemic stroke and/or death. Methods: We performed a post-hoc analysis of data from the National Institute of Neurological Disorders and Stroke (NINDS) intravenous recombinant tissue plasminogen activator (rt-PA) trial and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). Multivariate analysis was used to calculate the odds ratio (OR) of recurrent stroke and recurrent stroke or death for aspirin treatment failure patients for the duration of available follow-up (3 months for TOAST patients; 12 months for NINDS rt-PA trial patients). Results: The rate of aspirin treatment failure was 40% and 35% among 1275 patients and 624 patients recruited in the TOAST and NINDS rt-PA trials, respectively. The risk of stroke and death at 3 months and 1 year was not higher among patients classified as aspirin treatment failures among the TOAST (OR 1.1; 95% confidence interval [CI] 0.8-1.6; P =.7) or NINDS rt-PA trial patients (OR 0.8; 95% CI 0.6-1.3; P =.4), respectively. In subgroup analysis, aspirin treatment failure was not found to be associated with recurrent stroke or with the combined endpoint of stroke and death among categories defined by etiologic subtype, including those with large artery atherosclerosis. Conclusions: In a post-hoc analysis of 2 randomized ischemic stroke trials, aspirin treatment failure was not found to be associated with an increased risk of recurrent stroke or death.",

keywords = "Aspirin resistance, aspirin treatment failure, ischemic stroke",

author = "Georgiadis, {Alexandros L.} and Cordina, {Steve M.} and Gabriela Vazquez and Nauman Tariq and Suri, {M. Fareed K.} and Kamakshi Lakshminarayan and Adams, {Harold P.} and Qureshi, {Adnan I.}",

note = "Funding Information: Dr. Lakshminarayan is on the adverse events committee for CVRx and AGA Medical, both device manufacturers. She is funded by National Institutes of Health Grant K23NS051377 , is a coinvestigator for the Centers for Disease Control and Prevention Grant U58DP000857 , and received support from an American Academy of Neurology fellowship ( #84500-2002 ). Dr. Adams has received financial support from NMT Medical, Schering-Plough, Medtronic, and Merck . Dr. Qureshi has received funding from National Institutes of Health RO-1-NS44976-01A2 (medication provided by ESP Pharma), the American Heart Association Established Investigator Award 0840053N , and the Minnesota Medical Foundation , Minneapolis, MN. Drs. Georgiadis, Cordina, Vazquez, Tariq, and Suri have no conflicts of interest to disclose. ",

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language = "English (US)",

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T1 - Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke

AU - Georgiadis, Alexandros L.

AU - Cordina, Steve M.

AU - Vazquez, Gabriela

AU - Tariq, Nauman

AU - Suri, M. Fareed K.

AU - Lakshminarayan, Kamakshi

AU - Adams, Harold P.

AU - Qureshi, Adnan I.

N1 - Funding Information: Dr. Lakshminarayan is on the adverse events committee for CVRx and AGA Medical, both device manufacturers. She is funded by National Institutes of Health Grant K23NS051377 , is a coinvestigator for the Centers for Disease Control and Prevention Grant U58DP000857 , and received support from an American Academy of Neurology fellowship ( #84500-2002 ). Dr. Adams has received financial support from NMT Medical, Schering-Plough, Medtronic, and Merck . Dr. Qureshi has received funding from National Institutes of Health RO-1-NS44976-01A2 (medication provided by ESP Pharma), the American Heart Association Established Investigator Award 0840053N , and the Minnesota Medical Foundation , Minneapolis, MN. Drs. Georgiadis, Cordina, Vazquez, Tariq, and Suri have no conflicts of interest to disclose.

PY - 2013/2

Y1 - 2013/2

N2 - Background: The prognostic value of occurrence of ischemic stroke in a patient despite aspirin treatment (aspirin treatment failure) is not known. Our objective was to determine if aspirin treatment failure predicts recurrent ischemic stroke and/or death. Methods: We performed a post-hoc analysis of data from the National Institute of Neurological Disorders and Stroke (NINDS) intravenous recombinant tissue plasminogen activator (rt-PA) trial and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). Multivariate analysis was used to calculate the odds ratio (OR) of recurrent stroke and recurrent stroke or death for aspirin treatment failure patients for the duration of available follow-up (3 months for TOAST patients; 12 months for NINDS rt-PA trial patients). Results: The rate of aspirin treatment failure was 40% and 35% among 1275 patients and 624 patients recruited in the TOAST and NINDS rt-PA trials, respectively. The risk of stroke and death at 3 months and 1 year was not higher among patients classified as aspirin treatment failures among the TOAST (OR 1.1; 95% confidence interval [CI] 0.8-1.6; P =.7) or NINDS rt-PA trial patients (OR 0.8; 95% CI 0.6-1.3; P =.4), respectively. In subgroup analysis, aspirin treatment failure was not found to be associated with recurrent stroke or with the combined endpoint of stroke and death among categories defined by etiologic subtype, including those with large artery atherosclerosis. Conclusions: In a post-hoc analysis of 2 randomized ischemic stroke trials, aspirin treatment failure was not found to be associated with an increased risk of recurrent stroke or death.

AB - Background: The prognostic value of occurrence of ischemic stroke in a patient despite aspirin treatment (aspirin treatment failure) is not known. Our objective was to determine if aspirin treatment failure predicts recurrent ischemic stroke and/or death. Methods: We performed a post-hoc analysis of data from the National Institute of Neurological Disorders and Stroke (NINDS) intravenous recombinant tissue plasminogen activator (rt-PA) trial and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). Multivariate analysis was used to calculate the odds ratio (OR) of recurrent stroke and recurrent stroke or death for aspirin treatment failure patients for the duration of available follow-up (3 months for TOAST patients; 12 months for NINDS rt-PA trial patients). Results: The rate of aspirin treatment failure was 40% and 35% among 1275 patients and 624 patients recruited in the TOAST and NINDS rt-PA trials, respectively. The risk of stroke and death at 3 months and 1 year was not higher among patients classified as aspirin treatment failures among the TOAST (OR 1.1; 95% confidence interval [CI] 0.8-1.6; P =.7) or NINDS rt-PA trial patients (OR 0.8; 95% CI 0.6-1.3; P =.4), respectively. In subgroup analysis, aspirin treatment failure was not found to be associated with recurrent stroke or with the combined endpoint of stroke and death among categories defined by etiologic subtype, including those with large artery atherosclerosis. Conclusions: In a post-hoc analysis of 2 randomized ischemic stroke trials, aspirin treatment failure was not found to be associated with an increased risk of recurrent stroke or death.

KW - Aspirin resistance

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Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke

Abstract

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