Abstract
Aims
The REDUCE study demonstrated a reduction in the risk of recurrent stroke with patent
foramen ovale closure and antiplatelet therapy compared to antiplatelet therapy alone.
The clinicians were allowed to choose among aspirin, clopidogrel, or aspirin/dipyridamole
with the expectation that all antiplatelet therapies would have similar efficacy in
this population. We tested that presumption by comparing recurrent stroke rates among
antiplatelet agents within the control arm of the trial.
Methods
We evaluated patients in REDUCE study who were randomized to the medical arm. The
primary endpoint for this analysis was freedom from clinical ischemic stroke through
at least 2 years of follow-up, to a maximum of 5 years. In the primary analysis, antiplatelet
treatment was defined as the agent during the week prior to a recurrent stroke or
last known contact.
Results
Of 223 patients in the medical treatment arm, the initial agent was aspirin 52%, clopidogrel
30%, and aspirin/dipyridamole 12%. Patients treated with aspirin were similar to those
treated with alternatives, but were more likely to be enrolled in the United States.
The last reported agent was aspirin alone in 55%, clopidogrel alone in 31%, aspirin/dipyridamole
in 7%, and other/nothing/missing in 7%. Recurrent stroke rates were similar for all
3 antiplatelet regimens in unadjusted and adjusted analyses, with no overall difference
among agents (P= .17).
Conclusions
Among patients with patent foramen ovale-associated stroke who were managed medically,
there were no differences among antiplatelet agents in the risk of recurrent stroke,
though confidence intervals were wide.
Key Words
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References
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Article info
Publication history
Published online: February 07, 2020
Accepted:
December 22,
2019
Received:
November 23,
2019
Footnotes
Funding: This work was supported by WL Gore and Associates.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104632
Copyright
© 2019 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to ‘Comparison of Antiplatelet Therapies for Prevention of Patent Foramen Ovale-Associated Stroke’ [Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 4 (April), 2020: 104632]Journal of Stroke and Cerebrovascular DiseasesVol. 29Issue 8
