Stroke patients with neurologic impairment face greater recurrence risk :- Medznat
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Neurologic deficits are associated with higher risk of stroke recurrence

Stroke Stroke
Stroke Stroke

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In people with minor stroke, disabling neurological symptoms are linked to a heightened risk of recurrent stroke. DAPT is more effective than aspirin alone to reduce further stroke risk within 90 days, regardless of neurologic disability status.

According to the findings of a study led by Chong Han et al., patients with minor stroke face a higher risk of recurrence if they present with disabling neurologic deficits (DNDs). However, the therapeutic advantage of dual antiplatelet therapy (DAPT) remains consistent, regardless of neurological involvement. This new assessment from the landmark CHANCE (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) trial aimed to explore the clinical outcomes in a subset of 3,725 minor stroke sufferers, stratified by the presence or absence of DNDs.
These deficits were identified via the National Institutes of Health Stroke Scale (NIHSS) at baseline. Of the total cohort, 1,918 patients (51.5%) were classified as having DNDs, while 1,807 patients (48.5%) did not have DNDs. At 90-day follow-up, stroke recurrence was quite higher among those with DNDs than in those without DNDs, indicating that even minor strokes with disabling features carry a greater risk of early recurrence (Table 1).

However, DAPT with clopidogrel and aspirin was shown to diminish the risk of recurrent stroke across both subgroups. Compared to aspirin alone, the combination therapy lowered recurrence risk by 26% in patients with DNDs (adjusted hazard ratio [HR]: 0.74) and by 36% in those without DNDs (adjusted HR: 0.64). Importantly, there was no pivotal interaction between DND status and treatment effect (interaction P=0.634), suggesting that the efficacy of dual therapy is not influenced by the presence of neurologic disability.

Researchers conclude that patients with minor stroke and DNDs are at elevated risk for early recurrent stroke, emphasizing the need for prompt and effective secondary prevention strategies. The findings reinforce the value of DAPT in this population and support its use regardless of neurologic impairment status. This analysis further extends the evidence base for clinicians considering early treatment decisions in minor stroke patients, especially when functional impairments are present.

Source:

Journal of the American Heart Association

Article:

Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke

Authors:

Chong Han et al.

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