Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

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  • معلومة اضافية
    • Subject Terms:
    • Abstract:
      Summary Background Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events.
    • Abstract:
      Findings Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92).
    • Abstract:
      Interpretation These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention.
    • Abstract:
      Funding British Heart Foundation.
    • ISSN:
      0140-6736
    • Accession Number:
      10.1016/S0140-6736(19)30840-2
    • Accession Number:
      S0140673619308402
    • Copyright:
      © 2019 The Author(s). Published by Elsevier Ltd.
  • Citations
    • ABNT:
      AL-SHAHI SALMAN, R. et al. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. The Lancet, [s. l.], v. 393, n. 10191, p. 2613–2623, 2019. DOI 10.1016/S0140-6736(19)30840-2. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S0140673619308402&custid=s8280428. Acesso em: 10 dez. 2019.
    • AMA:
      Al-Shahi Salman R, Dennis M, Sandercock P, et al. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. The Lancet. 2019;393(10191):2613-2623. doi:10.1016/S0140-6736(19)30840-2.
    • APA:
      Al-Shahi Salman, R., Dennis, M., Sandercock, P., Sudlow, C., Wardlaw, J., Whiteley, W., … Thomas, K. (2019). Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. The Lancet, 393(10191), 2613–2623. https://doi.org/10.1016/S0140-6736(19)30840-2
    • Chicago/Turabian: Author-Date:
      Al-Shahi Salman, Rustam, MS Dennis, PAG Sandercock, CLM Sudlow, JM Wardlaw, WN Whiteley, GD Murray, et al. 2019. “Effects of Antiplatelet Therapy after Stroke Due to Intracerebral Haemorrhage (RESTART): A Randomised, Open-Label Trial.” The Lancet 393 (10191): 2613–23. doi:10.1016/S0140-6736(19)30840-2.
    • Harvard:
      Al-Shahi Salman, R. et al. (2019) ‘Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial’, The Lancet, 393(10191), pp. 2613–2623. doi: 10.1016/S0140-6736(19)30840-2.
    • Harvard: Australian:
      Al-Shahi Salman, R, Dennis, M, Sandercock, P, Sudlow, C, Wardlaw, J, Whiteley, W, Murray, G, Stephen, J, Newby, D, Sprigg, N, Werring, D, White, P, Baigent, C, Lasserson, D, Sullivan, F, Carrie, J, Rojas, J, Amoils, S, Bamford, J, Armitage, J, Rinkel, G, Lowe, G, Emberson, J, Innes, K, Dinsmore, L, Drever, J, Williams, C, Perry, D, McGill, C, Buchanan, D, Walker, A, Hutchison, A, Matthews, C, Fraser, R, McGrath, A, Deary, A, Anderson, R, Walker, P, Hansen, C, Parker, R, Rodriguez, A, Macleod, M, Gattringer, T, Palmer, J, Sakka, E, Adil-Smith, J, Minks, D, Mitra, D, Bhatnagar, P, du Plessis, J, Joshi, Y, Lerpiniere, C, O’Brien, R, Burgess, S, Mead, G, Paulton, R, Doubal, F, McCormick, K, Hunter, N, Taylor, P, Parakramawansha, R, Perry, J, Blair, G, MacRaild, A, Parry-Jones, A, Johnes, M, Lee, S, Shaw, KM, Burger, I, Punter, M, Ingham, A, Perez, J, Naing, Z, Morell, J, Marsden, T, Hall, A, Marshall, S, Harrison, L, Jarapa, R, Wood, E, O’Loughlin, V, Cohen, D, Davies, S, Njoku, K, Mpelembue, M, Burgess, L, Licenik, R, Ngwako, M, Nisar, N, Niranchanan, R, Roganova, T, Bathula, R, Devine, J, David, A, Oshodi, A, Guo, F, Owoyele, E, Sukdeo, V, Ballantine, R, et al. 2019, ‘Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial’, The Lancet, vol. 393, no. 10191, pp. 2613–2623, viewed 10 December 2019, .
    • MLA:
      Al-Shahi Salman, Rustam, et al. “Effects of Antiplatelet Therapy after Stroke Due to Intracerebral Haemorrhage (RESTART): A Randomised, Open-Label Trial.” The Lancet, vol. 393, no. 10191, June 2019, pp. 2613–2623. EBSCOhost, doi:10.1016/S0140-6736(19)30840-2.
    • Chicago/Turabian: Humanities:
      Al-Shahi Salman, Rustam, MS Dennis, PAG Sandercock, CLM Sudlow, JM Wardlaw, WN Whiteley, GD Murray, et al. “Effects of Antiplatelet Therapy after Stroke Due to Intracerebral Haemorrhage (RESTART): A Randomised, Open-Label Trial.” The Lancet 393, no. 10191 (June 29, 2019): 2613–23. doi:10.1016/S0140-6736(19)30840-2.
    • Vancouver/ICMJE:
      Al-Shahi Salman R, Dennis M, Sandercock P, Sudlow C, Wardlaw J, Whiteley W, et al. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. The Lancet [Internet]. 2019 Jun 29 [cited 2019 Dec 10];393(10191):2613–23. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S0140673619308402&custid=s8280428