Antiplatelet use and CADASIL: a retrospective observational analysis

Area of Science:

• Neurology
• Vascular Neurology
• Genetics

Background:

• Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) involves microangiopathy and commonly uses antiplatelet medications for stroke prevention.
• The therapeutic benefit of antiplatelet agents in CADASIL remains unproven.

Purpose of the Study:

• To investigate the impact of antiplatelet therapy on the incidence of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) in individuals diagnosed with CADASIL.

Main Methods:

• A retrospective analysis of anonymized data from the TriNetX Research Network (October 2015 - January 2021) was conducted.
• Individuals with an ICD-10 code for CADASIL (I67.850) were identified.
• The study assessed the incidence of AIS (I63) and ICH (I61) in relation to antiplatelet medication use for at least one month prior, using age-adjusted logistic regression.

Main Results:

• The study included 455 individuals, with 40 (8.8%) exposed to antiplatelet therapy.
• Antiplatelet users were older (61±12 years) than unexposed individuals (57±14 years).
• No significant difference was observed in AIS rates (23% vs. 14%) or ICH rates (3% vs. 5%) between the groups. Antiplatelet use did not significantly impact AIS likelihood (OR 1.62, p=0.23).

Conclusions:

• Current antiplatelet therapy does not appear to significantly alter the incidence of AIS or ICH in individuals with suspected CADASIL.
• The findings underscore the necessity for enhanced understanding of CADASIL pathophysiology to develop disease-modifying treatments.