Comparative Effectiveness of Prestroke Aspirin on Stroke Severity and Outcome

Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik Hong, Kyung Bok Lee, Tai Hwan Park, Soo Joo Lee, Youngchai Ko, Moon Ku Han, Jun Lee, Jae Kwan Cha, Dae Hyun Kim, Dong Eog Kim, Joon Tae Kim, Jay Chol Choi, Kyung Ho Yu, Byung Chul Lee, Ji Sung Lee, Juneyoung Lee, Philip B. GorelickHee Joon Bae

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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.

Original languageEnglish
Pages (from-to)560-568
Number of pages9
JournalAnnals of Neurology
Volume79
Issue number4
DOIs
Publication statusPublished - 2016 Apr 1

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ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Park, J. M., Kang, K., Cho, Y. J., Hong, K. S., Lee, K. B., Park, T. H., Lee, S. J., Ko, Y., Han, M. K., Lee, J., Cha, J. K., Kim, D. H., Kim, D. E., Kim, J. T., Choi, J. C., Yu, K. H., Lee, B. C., Lee, J. S., Lee, J., ... Bae, H. J. (2016). Comparative Effectiveness of Prestroke Aspirin on Stroke Severity and Outcome. Annals of Neurology, 79(4), 560-568. https://doi.org/10.1002/ana.24602