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Author response: Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
We appreciate Drs. Gutierrez and Lekic's emphasis on the time-course analysis of dual antiplatelet therapy (DAPT) by intracranial arterial stenosis (ICAS) in their comments on our article.1 Only 1,089 patients were included in the imaging substudy.2 In patients with ICAS, 19 (8.2%), 3 (1.3%), and 0 ischemic strokes in the DAPT group (n = 231) vs 25 (10.0%), 6 (2.4%), and 0 in the aspirin alone group (n = 250), and 4 (1.7%), 0, and 2 (0.9%) bleeding in the DAPT group vs 1 (0.4%), 0, and 0 in the aspirin alone group, occurred at the first, second, and third week, respectively. In patients without ICAS, 11 (3.7%), 1 (0.3%), a...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Pan, Y., Wang, Y., Wang, Y. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Individualized risk prediction of major bleeding in secondary stroke prevention: Are we there yet?
In most patients diagnosed with a TIA or ischemic stroke, secondary stroke prevention relies on antiplatelet therapy unless anticoagulation is indicated. Aspirin has the largest evidence base and reduces the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications.1 Because antiplatelet therapy typically continues for many years, clinicians and patients need an estimation of the annual bleeding risk to accurately assess future risk. In a meta-analysis of 25 randomized trials of antiplatelet therapy in primary or secondary prevention of cardiovascular disease, aspirin increased the abs...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lemmens, R., Al-Shahi Salman, R. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction EDITORIALS Source Type: research

Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED
Conclusions: The S2TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding.
Source: Neurology - August 28, 2017 Category: Neurology Authors: Hilkens, N. A., Algra, A., Diener, H.-C., Reitsma, J. B., Bath, P. M., Csiba, L., Hacke, W., Kappelle, L. J., Koudstaal, P. J., Leys, D., Mas, J.-L., Sacco, R. L., Amarenco, P., Sissani, L., Greving, J. P., For the Cerebrovascular Antiplatelet Trialists' Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction ARTICLE Source Type: research

Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
Conclusions: Clopidogrel–aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. Clinicaltrials.gov identifier: NCT00979589. Classification of evidence: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
Source: Neurology - May 15, 2017 Category: Neurology Authors: Pan, Y., Jing, J., Chen, W., Meng, X., Li, H., Zhao, X., Liu, L., Wang, D., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE investigators Tags: All Cerebrovascular disease/Stroke, Clinical trials Randomized controlled (CONSORT agreement) ARTICLE Source Type: research

Resumption of Antithrombotic Therapy in LVAD-associated Intracranial Hemorrhages (P2.273)
Conclusions:Among survivors of LVAD-associated ICH, those who resumed both antiplatelet plus warfarin therapy had fewer ischemic, but more hemorrhagic events than those who resumed antiplatelet therapy alone.Disclosure: Dr. Cho has nothing to disclose. Dr. Frontera has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Cho, S.-M., Frontera, J. Tags: Intracerebral Hemorrhage Source Type: research

Safety of OnabotulinumtoxinA Treatment With Concomitant Antithrombotic Therapy in Patients With Post-stroke Spasticity: A Pooled Analysis of Randomized, Double-Blind Studies (S56.008)
Conclusions:There is no apparent increased risk of bleeding complications in patients on antithrombotics following IM onabotA treatment; nonetheless, careful observation of the injection site and patient education of the potential for bleeding complications remain warranted.Study Supported by: Allergan plc, Dublin, IrelandDisclosure: Dr. Dimitrova has received personal compensation for activities with Allergan as an employee. Dr. Dimitrova holds stock and/or stock options in Allergan. Dr. James has received personal compensation for activities with Allergan and Chase Pharmaceuticals as an employee. Dr. Liu has received per...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Dimitrova, R., James, L., Liu, C., Orejudos, A., Yushmanova, I., Brin, M. Tags: Movement Disorders: Huntington ' s Disease and Drug-Induced Dyskinesias Source Type: research

Aspirin use is associated with decreased initial stroke severity in patients with acute ischemic stroke: Pilot study (P6.293)
Conclusions:Aspirin appears to decrease the severity of AIS in a dose response fashion. We were unable to observe the effect of aspirin in the acetylation of albumin. Acetylation of additional proteins will be studied in an attempt to identify patients who respond best to aspirin.Disclosure: Dr. Jensen has nothing to disclose. Dr. Leonard has nothing to disclose. Dr. Bar-Or has nothing to disclose. Dr. Rael has nothing to disclose. Dr. Bartt has nothing to disclose. Dr. Wagner has received personal compensation for activities with Genentech as a speaker. Dr. Bar-Or has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Jensen, J., Leonard, J., Bar-Or, R., Rael, L., Bartt, R., Wagner, J., Bar-Or, D. Tags: Prevention of Cerebrovascular Disease Source Type: research

The History of Aspirin: from Willow Bark to Thomas Edison in the 20th Century (P2.391)
CONCLUSION: The evolution of Aspirin in the 20th century aligned with historical events leading to its place as one of the most widely used drugs in history.Disclosure: Dr. Southerland has received personal compensation in an editorial capacity for Neurology podcast.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Southerland, A. Tags: History of Neurology Source Type: research

Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE
Conclusions: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
Source: Neurology - September 28, 2015 Category: Neurology Authors: Liu, L., Wong, K. S. L., Leng, X., Pu, Y., Wang, Y., Jing, J., Zou, X., Pan, Y., Wang, A., Meng, X., Wang, C., Zhao, X., Soo, Y., Johnston, S. C., Wang, Y., For the CHANCE Investigators Tags: ARTICLE Source Type: research

Delay of Percutaneous Gastrostomy Tube (PEG) Placement in Patients with Ischemic Stroke in a Large Urban Hospital. (P1.063)
CONCLUSIONS: Our study shows that hypertension, use of AA agents and use of tPA puts stroke patients at risk of having a delay in PEG placement. Prior studies have shown that aspirin use is not associated with increased bleeding complications during PEG placement. Education can help avoid delay in PEG tube placement due to aspirin use. Early PEG placement in ischemic stroke patients may improve clinical outcome and decrease hospital costs.Disclosure: Dr. Raval has nothing to disclose. Dr. Rayi has nothing to disclose. Dr. Jacob has nothing to disclose. Dr. Hillen has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Raval, B., Rayi, A., Jacob, M., Hillen, M. Tags: Cerebrovascular Disease and Interventional Neurology: Epidemiology Source Type: research

Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probabl...
Source: Neurology - February 24, 2014 Category: Neurology Authors: Culebras, A., Messe, S. R., Chaturvedi, S., Kase, C. S., Gronseth, G. Tags: All Cerebrovascular disease/Stroke SPECIAL ARTICLE Source Type: research

ASA failure: Does the combination ASA/clopidogrel confer better long-term vascular protection?
Conclusions: In patients with a recent lacunar stroke while taking ASA, the addition of clopidogrel did not result in reduction of vascular events vs continuing ASA only. Classification of evidence: This study provides Class I evidence that for patients with recent lacunar stroke while taking ASA, adding clopidogrel as compared to continuing ASA alone does not reduce the risk of recurrent stroke.
Source: Neurology - February 3, 2014 Category: Neurology Authors: Cote, R., Zhang, Y., Hart, R. G., McClure, L. A., Anderson, D. C., Talbert, R. L., Benavente, O. R. Tags: Stroke prevention, Infarction ARTICLE Source Type: research

Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review with practice recommendations. Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients underg...
Source: Neurology - May 27, 2013 Category: Neurology Authors: Armstrong, M. J., Gronseth, G., Anderson, D. C., Biller, J., Cucchiara, B., Dafer, R., Goldstein, L. B., Schneck, M., Messe, S. R. Tags: Ultrasound, All Medical/Systemic disease, All Neuro-ophthalmology, All Cerebrovascular disease/Stroke, All Trauma SPECIAL ARTICLE Source Type: research