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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

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dc.contributor.author Hart, Robert G.
dc.contributor.author Veltkamp, Roland C.
dc.contributor.author Sheridan, Patrick
dc.contributor.author Sharma, Mukul
dc.contributor.author Kasner, Scott E.
dc.contributor.author Bangdiwala, Shrikant I.
dc.contributor.author Ntaios, George
dc.contributor.author Shoamanesh, Ashkan
dc.contributor.author Ameriso, Sebastián Francisco
dc.contributor.author Toni, Danilo
dc.contributor.author Czlonkowska, Anna
dc.contributor.author Lindgren, Arne
dc.contributor.author Hankey, Graeme J.
dc.contributor.author Perera, Kanjana S.
dc.contributor.author Shuaib, Ashfaq
dc.contributor.author Coutts, Shelagh B.
dc.contributor.author Gagliardi, Rubens J.
dc.contributor.author Berkowitz, Scott D.
dc.contributor.author Mundl, Hardi
dc.contributor.author NAVIGATE ESUS Investigators
dc.date.accessioned 2020-12-11T11:41:49Z
dc.date.available 2020-12-11T11:41:49Z
dc.date.issued 2019-05-31
dc.identifier.citation Hart RG, Veltkamp RC, Sheridan P, Sharma M, Kasner SE, Bangdiwala SI, Ntaios G, Shoamanesh A, Ameriso SF, Toni D, Czlonkowska A, Lindgren A, Hankey GJ, Perera KS, Shuaib A, Coutts SB, Gagliardi RJ, Berkowitz SD, Mundl H, Peters G, Connolly SJ; NAVIGATE ESUS Investigators. 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.J Stroke Cerebrovasc Dis 2019;28:2273-2279. en_US
dc.identifier.uri https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.05.014
dc.identifier.uri https://repositorio.fleni.org.ar/handle/123456789/261
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. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Aspirin en_US
dc.subject Aspirina en_US
dc.subject Brain Ischemia en_US
dc.subject Isquemia Encefálica en_US
dc.subject Factor Xa Inhibitors en_US
dc.subject Inhibidores del Factor Xa en_US
dc.subject Intracranial Embolism en_US
dc.subject Embolia Intracraneal en_US
dc.subject Risk Factors en_US
dc.subject Factores de Riesgo en_US
dc.subject Rivaroxaban en_US
dc.subject Stroke en_US
dc.subject Accidente Cerebrovascular en_US
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_US
dc.type info:eu-repo/semantics/publishedVersion
dc.type info:eu-repo/semantics/article en_US
dc.description.fil Fil: Hart, Robert G. Population Health Research Institute; Canadá.
dc.description.fil Fil: Veltkamp, Roland C. Imperial College London; Reino Unido.
dc.description.fil Fil: Sheridan, Patrick. Population Health Research Institute; Canadá.
dc.description.fil Fil: Sharma, Mukul. Population Health Research Institute; Canadá.
dc.description.fil Fil: Kasner, Scott E. University of Pennsylvania; Estados Unidos.
dc.description.fil Fil: Bangdiwala, Shrikant I. McMaster University; Canadá.
dc.description.fil Fil: Ntaios, George. University of Thessaly; Grecia.
dc.description.fil Fil: Shoamanesh, Ashkan. Population Health Research Institute; Canadá.
dc.description.fil Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Toni, Danilo. Sapienza University of Rome; Italia.
dc.description.fil Fil: Czlonkowska, Anna. Medical University of Warsaw; Polonia.
dc.description.fil Fil: Lindgren, Arne. Skane University Hospital; Suecia.
dc.description.fil Fil: Hankey, Graeme J. Sir Charles Gairdner Hospital; Australia.
dc.description.fil Fil: Perera, Kanjana S. Population Health Research Institute; Canadá.
dc.description.fil Fil: Shuaib, Ashfaq. University of Alberta Hospital; Canadá.
dc.description.fil Fil: Coutts, Shelagh B. Hotchkiss Brain Institute; Canadá.
dc.description.fil Fil: Gagliardi, Rubens J. Irmandade da Santa Casa de Misericórdia de São Paulo; Brasil.
dc.description.fil Fil: Berkowitz, Scott D. Bayer; Estados Unidos.
dc.description.fil Fil: Mundl, Hardi. Bayer; Alemania.
dc.relation.ispartofVOLUME 28
dc.relation.ispartofNUMBER 8
dc.relation.ispartofPAGINATION 2273-2279
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Filadelfia
dc.relation.ispartofTITLE Journal of stroke and cerebrovascular diseases
dc.relation.ispartofISSN 1532-8511
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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