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Rivaroxaban versus aspirin for prevention of covert brain infarcts in patients with embolic stroke of undetermined source: NAVIGATE ESUS MRI substudy

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dc.contributor.author Sharma, Mukul
dc.contributor.author Smith, Eric E.
dc.contributor.author Pearce, Lesly A.
dc.contributor.author Perera, Kanjana S.
dc.contributor.author Kasner, Scott E.
dc.contributor.author Yoon, Byung-Woo
dc.contributor.author Ameriso, Sebastián Francisco
dc.contributor.author Puig, Josep
dc.contributor.author Damgaard, Dorte
dc.contributor.author Fiebach, Jochen B.
dc.contributor.author Muir, Keith W.
dc.contributor.author Veltkamp, Roland C.
dc.contributor.author Toni, Danilo
dc.contributor.author Shamalov, Nikolay
dc.contributor.author Gagliardi, Rubens J.
dc.contributor.author Mikulik, Robert
dc.contributor.author Engelter, Stefan T.
dc.contributor.author Bereczki, Daniel
dc.contributor.author O'Donnell, Martin J.
dc.contributor.author Saad, Feryal
dc.date.accessioned 2022-08-01T16:11:00Z
dc.date.available 2022-08-01T16:11:00Z
dc.date.issued 2021-11-18
dc.identifier.citation Sharma M, Smith EE, Pearce LA, Perera KS, Kasner SE, Yoon BW, Ameriso SF, Puig J, Damgaard D, Fiebach JB, Muir KW, Veltkamp RC, Veltkamp RC, Toni DS, Shamalov N, Gagliardi RJ, Mikulik R, Engelter ST, Bereczki D, O'Donnell MJ, Saad F, Shoamanesh A, Berkowitz SD, Mundl H, Hart RG; NAVIGATE ESUS MRI Substudy Investigators. Rivaroxaban versus aspirin for prevention of covert brain infarcts in patients with embolic stroke of undetermined source: NAVIGATE ESUS MRI substudy. Int J Stroke. 2021 Nov 18:17474930211058012. doi: 10.1177/17474930211058012 es_ES
dc.identifier.uri https://doi.org/10.1177/17474930211058012
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/643
dc.description.abstract Background Covert brain infarcts are associated with important neurological morbidity. Their incidence in patients with embolic stroke of undetermined source (ESUS) is unknown. Aims To assess the incidence of covert brain infarcts and cerebral microbleeds using MRI in a prospective substudy of the NAVIGATE ESUS randomized trial and to evaluate the effects of antithrombotic therapies. Methods At 87 sites in 15 countries, substudy participants were randomly assigned to receive rivaroxaban 15 mg daily or aspirin 100 mg daily and underwent brain MRI near randomization and after study termination. The primary outcome was incident brain infarct (clinical ischemic stroke or covert brain infarct). Brain infarcts and microbleeds were ascertained centrally by readers unaware of treatment. Treatment effects were estimated using logistic regression. Results Among the 718 substudy participants with interpretable, paired MRIs, the mean age was 67 years and 61% were men with a median of 52 days between the qualifying ischemic stroke and randomization and a median of seven days between randomization and baseline MRI. During the median (IQR) 11 (12) month interval between scans, clinical ischemic strokes occurred in 27 (4%) participants, while 60 (9%) of the remaining participants had an incident covert brain infarct detected by MRI. Assignment to rivaroxaban was not associated with reduction in the incidence of brain infarct (OR 0.77, 95% CI 0.49, 1.2) or of covert brain infarct among those without clinical stroke (OR 0.85, 95% CI 0.50, 1.4). New microbleeds were observed in 7% and did not differ among those assigned rivaroxaban vs. aspirin (HR 0.95, 95% CI 0.52–1.7). Conclusions Incident covert brain infarcts occurred in twice as many ESUS patients as a clinical ischemic stroke. Treatment with rivaroxaban compared with aspirin did not significantly reduce the incidence of covert brain infarcts or increase the incidence of microbleeds, but the confidence intervals for treatment effects were wide. es_ES
dc.language.iso eng es_ES
dc.publisher Sage es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Rivaroxaban es_ES
dc.subject Aspirin es_ES
dc.subject Aspirina es_ES
dc.subject Brain Infarction es_ES
dc.subject Infarto Encefálico es_ES
dc.subject Accidente Cerebrovascular Embólico es_ES
dc.subject Embolic Stroke es_ES
dc.title Rivaroxaban versus aspirin for prevention of covert brain infarcts in patients with embolic stroke of undetermined source: NAVIGATE ESUS MRI substudy es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Sharma, Mukul. McMaster University; Canadá.
dc.description.fil Fil: Smith, Eric E. University of Calgary; Canadá.
dc.description.fil Fil: Pearce, Lesly A. St. Catharines; Canadá.
dc.description.fil Fil: Perera, Kanjana S. McMaster University; Canadá.
dc.description.fil Fil: Kasner, Scott E. University of Pennsylvania; Estados Unidos.
dc.description.fil Fil: Yoon, Byung-Woo. Seoul National University Hospital; Corea del Sur.
dc.description.fil Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Puig, Josep. Hospital Dr. Josep Trueta; España.
dc.description.fil Fil: Damgaard, Dorte. Aarhus University Hospital; Dinamarca.
dc.description.fil Fil: Fiebach, Jochen B. Universitatsmedizin Berlin; Alemania.
dc.description.fil Fil: Muir, Keith W. University of Glasgow; Reino Unido.
dc.description.fil Fil: Veltkamp, Roland C. Imperial College London; Reino Unido.
dc.description.fil Fil: Toni, Danilo. Sapienza University of Rome; Italia.
dc.description.fil Fil: Shamalov, Nikolay. Federal Medical Biological Agency; Rusia.
dc.description.fil Fil: Gagliardi, Rubens J. Irmandade da Santa Casa de Misericórdia de São Paulo; Brasil
dc.description.fil Fil: Mikulik, Robert. Masaryk University; República Checa.
dc.description.fil Fil: Engelter, Stefan T. University of Basel; Suiza.
dc.description.fil Fil: Bereczki, Daniel. Semmelweis University; Hungría.
dc.description.fil Fil: O'Donnell, Martin J. National University Ireland; Irlanda.
dc.description.fil Fil: Saad, Feryal. University of Calgary; Canadá.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Thousand Oaks
dc.relation.ispartofTITLE International journal of stroke
dc.relation.ispartofISSN 1747-4949
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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