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Ischemic stroke outcome: racial differences in the trial of danaparoid in acute stroke (TOAST)
H Hassaballa1, P B Gorelick, C P West
1Department of Internal Medicine, Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612, USA. hhassaba@rush.edu
Insights
African-Americans had more stroke risk factors but similar outcomes to white patients in the Trial of ORG 10172 in Acute Stroke Therapy (TOAST). Younger age and lacunar infarction may predict better outcomes regardless of race.
Area of Science:
- Neurology
- Clinical Trials
- Public Health
Background:
- Stroke is a leading cause of disability and death.
- Racial disparities in stroke risk factors and outcomes are well-documented.
- Understanding these differences is crucial for effective acute stroke therapy.
Purpose of the Study:
- To investigate racial differences in baseline stroke risk factors and other measures within the Trial of ORG 10172 in Acute Stroke Therapy (TOAST).
- To assess how these differences may influence treatment response and patient outcomes.
Main Methods:
- A comparative analysis of demographic, medical, stroke, physical examination, CT, laboratory, and neurologic factors.
- Inclusion of 292 African-American and 801 white patients from the TOAST study.
- TOAST compared danaparoid (ORG 10172) with placebo in acute ischemic stroke patients treated within 24 hours.
Main Results:
- African-Americans were younger and had higher rates of hypertension, diabetes, congestive heart failure, prior strokes, higher diastolic blood pressure, more lacunar strokes, and greater prestroke disability.
- No significant differences were observed in 7-day outcomes, adverse events, serious bleeds, or hemorrhagic transformations between racial groups.
- A trend towards better outcomes in white patients at 7 days and at 3 months was noted, though very favorable outcomes at 3 months were similar.
Conclusions:
- Despite a higher burden of stroke risk factors, African-Americans demonstrated similar capacity to respond to acute stroke therapy compared to white patients.
- Younger age and the presence of lacunar infarction may be more significant predictors of favorable stroke outcomes than previously recognized.
- These findings highlight the need for personalized approaches to acute stroke management, considering individual patient factors beyond race.
Objective:
To determine racial differences in baseline stroke risk factors and other measures in the Trial of ORG 10172 in Acute Stroke Therapy (TOAST). Differences in these factors could influence response to acute stroke therapy and overall stroke outcome.
Methods:
The authors compared baseline demographic, medical, stroke, physical examination, CT, laboratory, and neurologic factors among 292 African-American and 801 white patients who enrolled in the TOAST study. TOAST compared danaparoid (ORG 10172) with placebo among acute ischemic stroke patients who were treated within 24 hours of stroke onset.
Results:
African-Americans were younger and more frequently had hypertension, diabetes mellitus, congestive heart failure, and prior strokes. In addition, African-Americans had higher mean diastolic blood pressure, more lacunar strokes, and more severe prestroke disability. There were no significant differences between African-Americans and white patients in outcomes at 7 days, overall number of adverse experiences, or occurrence of serious bleeds or hemorrhagic transformations. However, there was a trend toward a higher rate of favorable outcomes in white patients at 7 days. There was no significant difference in very favorable outcome at 3 months between African-American and white patients, but significantly more white patients had favorable outcome at 3 months.
Conclusion:
Although African-Americans possess a number of factors that should predict higher rates of poor stroke outcome after acute therapy, they have the capacity to respond similarly to white patients after acute stroke therapy. Perhaps younger age and presence of lacunar infarction are stronger predictors of good outcomes than was appreciated previously.
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