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Pathophysiologic, Rather than Laboratory-defined Resistance Drives Aspirin Failure in Ischemic Stroke
A significant proportion of ischemic strokes occur while using aspirin and therefore can be considered as clinical aspirin resistance. Apart from this clinical description, aspirin resistance can be defined by laboratory tests of in vitro platelet reactivity. The correlation between clinical and laboratory-defined resistance, however, is far from perfect, and the heterogenous nature of stroke pathophysiology might play a role in this discrepancy.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2015 Category: Neurology Authors: Nergiz Agayeva, Levent Gungor, Mehmet Akif Topcuoglu, Ethem Murat Arsava Source Type: research

Relationship between Inflammation and Aspirin and Clopidogrel Antiplatelet Responses in Acute Ischemic Stroke
We measured serum levels of proinflammatory/prothrombotic markers P-selectin, CD40L, matrix metalloproteinase 9 (MMP-9), intracellular adhesion molecule 1 (ICAM-1), and interleukin (IL)-6 in ischemic stroke patients, correlating their levels with the results of aspirin (ASA) and clopidogrel antiplatelet responses, using 3 “point of care” platelet function instruments, thromboelastograph (TEG), Accumetrics (ACU), and impedance aggregometer (IMP).
Source: Journal of Stroke and Cerebrovascular Diseases - November 12, 2015 Category: Neurology Authors: Zohara Sternberg, Trevor Chichelli, Daniel Sternberg, Robert Sawyer, Marilou Ching, David Janicke, Julian L. Ambrus, Jinhee Yu, Frederick Munschauer Source Type: research

Cerebral Microbleeds Meta-analyses of Prospective Studies: The Need to Consider Both Ischemic and Hemorrhagic Stroke Outcomes
I read with interest the recent meta-analysis by Wang et al,1 reporting a high risk of intracerebral hemorrhage (ICH) in ischemic stroke/transient ischemic attack patients with cerebral microbleeds—especially those with multiple lesions or taking aspirin. The paper largely corroborates findings of a previous meta-analysis on the topic,2 but also presents some clinically relevant new observations. A key new result is that the presence of a single microbleed (compared to no microbleeds) does not seem to significantly increase the risk of future ICH in this patient population (relative risk: 2.33, 95% confidence interval: ...
Source: Journal of Stroke and Cerebrovascular Diseases - January 13, 2016 Category: Neurology Authors: Andreas Charidimou Tags: Letter to the Editor Source Type: research

Interaction between COX-1 and COX-2 Variants Associated with Aspirin Resistance in Chinese Stroke Patients
There have been conflicting results for the association between cyclooxygenase (COX) genetic variants and aspirin resistance (AR). The aim of this study was to investigate the association of the COX genetic variants and interaction among these variants with AR in patients with acute ischemic stroke (IS).
Source: Journal of Stroke and Cerebrovascular Diseases - June 14, 2016 Category: Neurology Authors: Xingyang Yi, Wen Cheng, Jing Lin, Qiang Zhou, Chun Wang Source Type: research

Aspirin platelet reactivity on platelet function and clinical outcome in minor stroke or transient ischemic attack
Whether aspirin platelet reactivity affects platelet function and clinical outcomes with different antiplatelet therapies in patients with mild stroke or transient ischemic attack (TIA) remains unclear. We conducted a subgroup analysis of the PRINCE trial.
Source: Journal of Stroke and Cerebrovascular Diseases - July 29, 2022 Category: Neurology Authors: Yanjie Xu, Weiqi Chen, Lingling Jiang, Yicong Wang, Xingquan Zhao, Liping Liu, Dongxiao Yao, Lei Guo, Yongjun Wang, Yuesong Pan, Yilong Wang Source Type: research

Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment
We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.
Source: Journal of Stroke and Cerebrovascular Diseases - August 24, 2022 Category: Neurology Authors: Wouter van der Steen, P. Matthijs van der Sluijs, Rob A. van de Graaf, Ruisheng Su, Lennard Wolff, Henk van Voorst, Heleen M. den Hertog, Pieter Jan van Doormaal, Adriaan C.G.M. van Es, Julie Staals, Wim van Zwam, Hester F. Lingsma, Ren é van den Berg, C Source Type: research

The Effect of Acute Medication with Cilostazol, an Anti-platelet Drug, on the Outcome of Small Vessel Brain Infarction
In conclusion, cilostazol reduced the risk of early neurologic deterioration of patients with small vessel brain infarction. It is eagerly desired to conduct a large randomized control trial.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2014 Category: Neurology Authors: Taizen Nakase, Masahiro Sasaki, Akifumi Suzuki Tags: Original Articles Source Type: research

Risk Factors Control and Early Recurrent Cerebral Infarction in Patients with Symptomatic Intracranial Atherosclerotic Disease
Stroke caused by intracranial atherosclerotic disease (IAD) has the highest risk of early recurrence when compared to other stroke subtypes.1 Despite intensive medical management, the 1-year recurrence risk is as high as 15%.2,3 Uncontrolled risk factors may substantially influence stroke recurrence in symptomatic IAD. In the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial, uncontrolled systolic blood pressure (SBP) (>140 mmHg) and elevated cholesterol (>200 mg/dL) were associated with increased recurrent stroke during follow-up.
Source: Journal of Stroke and Cerebrovascular Diseases - June 30, 2021 Category: Neurology Authors: Victor J. Del Brutto, David S. Liebeskind, Jose G. Romano, Iszet Campo-Bustillo, George Cotsonis, Azhar Nizam, Shyam Prabhakaran, MYRIAD investigators Source Type: research

Antiplatelet Therapy as a Risk Factor for Microbleeds in Intracerebral Hemorrhage Patients: Analysis Using Specific Antiplatelet Agents
Conclusions: Attention to microbleed-positive patients is necessary for the safe use of aspirin in order to avoid antiplatelet-associated hemorrhages, but prospective studies are needed to verify our results.
Source: Journal of Stroke and Cerebrovascular Diseases - July 12, 2012 Category: Neurology Authors: Hiromitsu Naka, Eiichi Nomura, Jyuri Kitamura, Eiji Imamura, Shinichi Wakabayashi, Masayasu Matsumoto Tags: Original Articles Source Type: research

Low-Molecular-Weight Heparin Is More Effective Than Aspirin in Preventing Early Neurologic Deterioration and Improving Six-Month Outcome
Conclusions: For patients with acute ischemic stroke, treatment with LMWH within 48 hours of stroke until 10 days later may reduce END and deep-vein thrombosis during the first 10 days. LMWH appears to have advantages over aspirin in certain subgroups, such as elderly patients and patients with posterior circulation and basilar artery stenosis.
Source: Journal of Stroke and Cerebrovascular Diseases - March 21, 2014 Category: Neurology Authors: Xingyang Yi, Jing Lin, Chun Wang, Biao Zhang, Wanzhang Chi Tags: Original Articles Source Type: research

Cilostazol Addition to Aspirin could not Reduce the Neurological Deterioration in TOAST Subtypes: ADS Post-Hoc Analysis
Our previous trial acute dual study (ADS) reported that dual antiplatelet therapy (DAPT) using cilostazol and aspirin did not reduce the rate of short-term neurological worsening in non-cardioembolic stroke patients. Present post-hoc analysis investigated whether the impact of combined cilostazol and aspirin differed among stroke subtypes and factors associated with neurological deterioration and/or stroke recurrence.
Source: Journal of Stroke and Cerebrovascular Diseases - December 2, 2020 Category: Neurology Authors: Junya Aoki, Yasuyuki Iguchi, Takao Urabe, Hiroshi Yamagami, Kenichi Todo, Shigeru Fujimoto, Koji Idomari, Nobuyuki Kaneko, Takeshi Iwanaga, Tadashi Terasaki, Ryota Tanaka, Nobuaki Yamamoto, Akira Tsujino, Koichi Nomura, Koji Abe, Masaaki Uno, Yasushi Okad Source Type: research

Atrial Cardiopathy Biomarkers and MRI-Based Infarct Patterns in Patients with Embolic Strokes of Undetermined Source
Embolic stroke of undetermined source (ESUS) refers to non-lacunar ischemic strokes without a well-recognized cardioembolic source or stenosis of a large vessel supplying the infarcted terroritory1 and accounts for 9-25% of all ischemic stroke cases.2 Although ESUS can be related to various potential sources of thromboembolism, the most prevalent embolic source seems to be the heart. Thus, ESUS may be more responsive to anticoagulant therapy than antiplatelet therapy.1 However, recent clinical trials have failed to confirm that oral anticoagulation lowers the risk of stroke recurrence, relative to aspirin.
Source: Journal of Stroke and Cerebrovascular Diseases - June 19, 2021 Category: Neurology Authors: Yoon-Kyung Lee, Byung-Cheol Gwak, Byeol-A Yoon, Dae-Hyun Kim, Jae-Kwan Cha Source Type: research

Clinical Features and Racial/Ethnic Differences Among the 3020 Participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial
This study examined the baseline characteristics, racial/ethnic differences, and geographic differences among participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. The SPS3 trial enrolled patients who experienced a symptomatic small subcortical stroke (lacunar stroke) within the previous 6 months and an eligible lesion on detected on magnetic resonance imaging. The patients were randomized, in a factorial design, to antiplatelet therapy (aspirin 325 mg daily plus clopidogrel 75 mg daily vs aspirin 325 mg daily plus placebo) and to one of two levels of systolic blood pressure targets (“intensive” [
Source: Journal of Stroke and Cerebrovascular Diseases - April 19, 2012 Category: Neurology Authors: Carole L. White, Jeff M. Szychowski, Ana Roldan, Marie-France Benavente, Edwin J. Pretell, Oscar H. Del Brutto, Carlos S. Kase, Antonio Arauz, Brett C. Meyer, Irene Meissner, Bart M. Demaerschalk, Leslie A. McClure, Christopher S. Coffey, Lesly A. Pearce, Tags: Original Articles Source Type: research

An Emergency Department Intervention to Increase Warfarin Use for Atrial Fibrillation
Conclusions: This practical stroke prevention quality improvement initiative was not associated with an increase in warfarin use among ED patients with AF.
Source: Journal of Stroke and Cerebrovascular Diseases - December 20, 2012 Category: Neurology Authors: Lesli E. Skolarus, Lewis B. Morgenstern, Phillip A. Scott, Lynda D. Lisabeth, Jillian B. Murphy, Erin M. Migda, Devin L. Brown Tags: Original Articles Source Type: research

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