dc.creator | Hart R.G., Veltkamp R.C., Sheridan P., Sharma M., Kasner S.E., Bangdiwala S.I., Ntaios G., Shoamanesh A., Ameriso S.F., Toni D., Czlonkowska A., Lindgren A., Hankey G.J., Perera K.S., Shuaib A., Coutts S.B., Gagliardi R.J., Berkowitz S.D., Mundl H., Peters G., Connolly S.J., NAVIGATE ESUS Investigators | en |
dc.date.accessioned | 2023-01-31T08:27:55Z | |
dc.date.available | 2023-01-31T08:27:55Z | |
dc.date.issued | 2019 | |
dc.identifier | 10.1016/j.jstrokecerebrovasdis.2019.05.014 | |
dc.identifier.issn | 10523057 | |
dc.identifier.uri | http://hdl.handle.net/11615/73911 | |
dc.description.abstract | Background: Embolic stroke of undetermined source (ESUS) identifies patients with cryptogenic ischemic stroke presumed due to embolism from several unidentified sources. Among patients with recent ESUS, we sought to determine independent predictors of recurrent ischemic stroke during treatment with aspirin or rivaroxaban and to assess the relative effects of these treatments according to risk. Methods: Exploratory analyses of 7213 participants in the NAVIGATE ESUS international trial who were randomized to aspirin 100 mg/day or rivaroxaban 15 mg/day and followed for a median of 11 months, during which time there were 309 first recurrent ischemic strokes (4.6% per year). Baseline features were correlated with recurrent stroke by multivariate analysis. Results: The 7 independent predictors of recurrent stroke were stroke or transient ischemic attack (TIA) prior to the qualifying stroke (hazard ratio [HR] 2.03 95% confidence internal [CI] 1.58-2.60), current tobacco user (HR 1.62, 95% CI 1.24-2.12), age (HR 1.02 per year increase, 95%CI 1.01-1.03), diabetes (HR 1.28, 95% CI 1.01-1.64), multiple acute infarcts on neuroimaging (HR 1.49, 95% CI 1.09-2.02), aspirin use prior to qualifying stroke (HR 1.34, 95% CI 1.02-1.70), and time from qualifying stroke to randomization (HR .98, 95% CI .97-.99). The rate of recurrent stroke rate was 2.6% per year for participants without any of these risk factors, and increased by an average of 45% for each independent predictor (P < .001). There were no significant interactions between treatment effects and independent stroke predictors or stroke risk status. Conclusions: In this large cohort of ESUS patients, several features including prior stroke or TIA, advanced age, current tobacco user, multiple acute infarcts on neuroimaging, and diabetes independently identified those with an increased risk of ischemic stroke recurrence. The relative effects of rivaroxaban and aspirin were similar across the spectrum of independent stroke predictors and recurrent stroke risk status. © 2019 Elsevier Inc. | en |
dc.language.iso | en | en |
dc.source | Journal of Stroke and Cerebrovascular Diseases | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85066339482&doi=10.1016%2fj.jstrokecerebrovasdis.2019.05.014&partnerID=40&md5=fb114435c00d689c6dff1f0a3628b013 | |
dc.subject | acetylsalicylic acid | en |
dc.subject | rivaroxaban | en |
dc.subject | acetylsalicylic acid | en |
dc.subject | anticoagulant agent | en |
dc.subject | blood clotting factor 10a inhibitor | en |
dc.subject | rivaroxaban | en |
dc.subject | aged | en |
dc.subject | algorithm | en |
dc.subject | aortic valve disease | en |
dc.subject | artery occlusion | en |
dc.subject | Article | en |
dc.subject | autopsy | en |
dc.subject | body mass | en |
dc.subject | brain infarction | en |
dc.subject | brain ischemia | en |
dc.subject | Canada | en |
dc.subject | cerebrovascular accident | en |
dc.subject | clinical assessment | en |
dc.subject | clinical feature | en |
dc.subject | controlled study | en |
dc.subject | diabetes mellitus | en |
dc.subject | diastolic blood pressure | en |
dc.subject | disease severity | en |
dc.subject | double blind procedure | en |
dc.subject | drug effect | en |
dc.subject | East Asian | en |
dc.subject | Eastern Europe | en |
dc.subject | embolic strokes of undetermined source | en |
dc.subject | embolic strokes of undetermined source | en |
dc.subject | Europe | en |
dc.subject | exploratory factor analysis | en |
dc.subject | female | en |
dc.subject | follow up | en |
dc.subject | human | en |
dc.subject | hypertension | en |
dc.subject | life history trait | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | mitral valve disease | en |
dc.subject | National Institutes of Health Stroke Scale | en |
dc.subject | neuroimaging | en |
dc.subject | North America | en |
dc.subject | patent foramen ovale | en |
dc.subject | phase 3 clinical trial | en |
dc.subject | prediction | en |
dc.subject | priority journal | en |
dc.subject | randomized controlled trial | en |
dc.subject | recurrent disease | en |
dc.subject | risk factor | en |
dc.subject | South and Central America | en |
dc.subject | stroke patient | en |
dc.subject | systolic blood pressure | en |
dc.subject | tobacco | en |
dc.subject | transesophageal echocardiography | en |
dc.subject | transient ischemic attack | en |
dc.subject | United States | en |
dc.subject | Western Europe | en |
dc.subject | brain embolism | en |
dc.subject | brain ischemia | en |
dc.subject | cerebrovascular accident | en |
dc.subject | clinical trial | en |
dc.subject | comparative study | en |
dc.subject | middle aged | en |
dc.subject | multicenter study | en |
dc.subject | recurrent disease | en |
dc.subject | risk assessment | en |
dc.subject | time factor | en |
dc.subject | treatment outcome | en |
dc.subject | Aged | en |
dc.subject | Anticoagulants | en |
dc.subject | Aspirin | en |
dc.subject | Brain Ischemia | en |
dc.subject | Double-Blind Method | en |
dc.subject | Factor Xa Inhibitors | en |
dc.subject | Female | en |
dc.subject | Humans | en |
dc.subject | Intracranial Embolism | en |
dc.subject | Male | en |
dc.subject | Middle Aged | en |
dc.subject | Recurrence | en |
dc.subject | Risk Assessment | en |
dc.subject | Risk Factors | en |
dc.subject | Rivaroxaban | en |
dc.subject | Stroke | en |
dc.subject | Time Factors | en |
dc.subject | Treatment Outcome | en |
dc.subject | W.B. Saunders | en |
dc.title | Predictors of Recurrent Ischemic Stroke in Patients with Embolic Strokes of Undetermined Source and Effects of Rivaroxaban Versus Aspirin According to Risk Status: The NAVIGATE ESUS Trial | en |
dc.type | journalArticle | en |