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Risk of Serious Bleeding with Antiplatelet Therapy for Secondary Prevention Post Ischemic Stroke in Middle East

Zeinab Awada1, Rim Abboud2, Samer Nasr3

  • 1Internal Medicine, Lebanese American University-Medical Center, Beirut, LBN.

Cureus
|August 22, 2019
PubMed

Insights

Dual antiplatelet therapy (DAPT) and high-dose aspirin increase stroke patients' bleeding risk, particularly between three months and one year. Advanced age and smoking further elevate this risk.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Stroke is a leading cause of mortality and disability globally.
  • Atherothrombosis is a primary cause of ischemic stroke, necessitating antiplatelet therapy for secondary prevention.
  • Existing antiplatelet therapies like aspirin and clopidogrel monotherapy reduce recurrent stroke risk, but safety concerns persist, especially regarding bleeding complications in stroke patients.

Purpose of the Study:

  • To assess the risk of serious bleeding in adult stroke patients undergoing antiplatelet therapy for secondary prevention.
  • To evaluate the impact of different antiplatelet therapies, including dosage and combinations, on bleeding risk.
  • To identify patient-related factors contributing to increased bleeding risk.

Main Methods:

  • A retrospective monocentric study involving 454 patients admitted for ischemic cerebrovascular accident (CVA) between 2010 and 2015.
  • Patients were discharged on antiplatelet therapy for secondary stroke prevention.
  • Patient records were analyzed to determine the incidence of major bleeding events post-therapy initiation.

Main Results:

  • The highest risk of serious bleeding was observed with aspirin 100 mg monotherapy and dual antiplatelet therapy (DAPT) (Aspirin 100 mg + Clopidogrel 75 mg).
  • Bleeding risk was elevated within the first three months of therapy, with the highest incidence occurring between three months and one year.
  • Advanced age and smoking were identified as significant patient-related factors increasing bleeding risk.

Conclusions:

  • Aspirin 100 mg monotherapy and DAPT are associated with the highest bleeding risk in stroke patients.
  • This elevated bleeding risk persists throughout antiplatelet therapy but is most pronounced between three months and one year post-initiation.
  • Patient factors such as advanced age and smoking significantly contribute to the risk of bleeding complications.

Keywords:
aspirinbleedingclopidogreldual anti plateletsischemic strokesecondary prevention

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