| Title: |
Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial |
| Authors: |
Salman, Rustam Al-Shahi; Minks, David P; Mitra, Dipayan; Rodrigues, Mark A; Bhatnagar, Priya; Plessis, Johann C du; Joshi, Yogish; Dennis, Martin S; Murray, Gordon D; Newby, David E; Sandercock, Peter A G; Sprigg, Nikola; Stephen, Jacqueline; Sudlow, Cathie L M; Werring, David J; Whiteley, William N; Wardlaw, Joanna M; White, Philip M; Baigent, Colin; Lasserson, Daniel; Sullivan, Frank; Carrie, Johanna; Rojas, Javier; Amoils, Shannon; Bamford, John; Armitage, Jane; Rinkel, Gabriel; Lowe, Gordon; Emberson, Jonathan; Innes, Karen; Dinsmore, Lynn; Drever, Jonathan; Williams, Carol; Perry, David; McGill, Connor; Buchanan, David; Walker, Allan; Hutchison, Aidan; Matthews, Christopher; Fraser, Ruth; McGrath, Aileen; Deary, Ann; Anderson, Rosemary; Walker, Pauli; Hansen, Christian; Parker, Richard; Rodriguez, Aryelly; Macleod, Malcolm; Gattringer, Thomas; Palmer, Jeb; Marigold, Richard |
| Publication Year: |
2019 |
| Collection: |
University of Southampton: e-Prints Soton |
| Description: |
Background:Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy.Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
Salman, Rustam Al-Shahi, Minks, David P, Mitra, Dipayan, Rodrigues, Mark A, Dennis, Martin S, Wardlaw, Joanna M, Sullivan, Frank, Macleod, Malcolm, Palmer, Jeb and Marigold, Richard , RESTART collaboration (2019) Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial. The Lancet. Neurology, 18 (7), 643-652. (doi:10.1016/s1474-4422(19)30184-x ). |
| Availability: |
https://eprints.soton.ac.uk/492349/ |
| Accession Number: |
edsbas.E841BE5F |
| Database: |
BASE |