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22. European Stroke Conference 5 Meta-analysis and reviews 17:10 - 17:20 Effects of daily aspirin in secondary prevention of stroke on cancer mortality and non-vascular death: analysis of individual patient data from randomised controlled trials A.M. Algra1, P.M. Rothwell2 Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, Univer-sity of Oxford,, Oxford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford,, Oxford, UNITED KINGDOM2 BACKGROUND: In recent years, guidelines have recommended either aspirin (+/- dipyrid-amole) or clopidogrel for secondary prevention of stroke. In 2010, the UK NICE guidelines went further and recommended clopidogrel over aspirin. However, it has since been shown that daily aspirin reduces the risk of death due to cancer and all-cause non-vascular death. We there-fore studied cancer deaths and all non-vascular deaths in all randomised trials of daily aspirin vs control in secondary prevention of stroke. METHODS: We did a systematic review of all randomised trials of daily aspirin vs no aspirin in primary or secondary prevention of vascular events and obtained individual patient data on cancer deaths and all deaths due to vascular and non-vascular causes during the trials. Pooled estimates (intention-to-treat analysis) of the effect of aspirin were derived from fixed-effects meta-analysis in the subset of trials of aspirin in secondary prevention of stroke and were com-pared with the effects in all trials. RESULTS: Allocation to aspirin reduced cancer deaths in all trials combined (562 vs 664, OR=0.85, 95%CI 0.76-0.96, p=0.008; 34 trials; 69,224 participants), resulting in fewer non-vascular deaths overall (1021 vs 1173; OR=0.88, 0.78-0.96, p=0.003; 51 trials; 77,549 participants). In the 12 trials (10,257 participants) in secondary prevention of stroke, aspirin re-duced cancer death (76 vs 99, OR=0.63, 95%CI 0.46-0.85, p=0.003) and all non-vascular death (171 vs 187, OR=0.78, 95%CI 0.63-0.96, p=0.024), but had no significant effect on vascular death (524 vs 446, OR=0.97, 95%CI 0.85-1.10, p=0.64), such that 87% (52/60) of all deaths prevented were non-vascular. CONCLUSIONS: Effects of daily aspirin on cancer death and non-vascular death in trials in secondary prevention of stroke were consistent with those in all trials. These effects should be taken into account in treatment guidelines on the choice of antiplatelet drugs in secondary pre-vention of stroke. 4 Meta-analysis and reviews 17:00 - 17:10 Impact of Onset-to-Reperfusion Time on Stroke Mortality : A collaborative-Pooled Analy-sis M. Mazighi1, S. A. Chaudhry2, M. Ribo3, P. Khatri4, M. Mokin5, J. Labreuche6, E. Meseguer7, S. D. Yeatts8, A. H. Siddiqui9, J. Broderick10, C. Molina11, A. I. Qureshi12, P. Amarenco13 Bichat University Hospital, Paris, FRANCE1,Zeenat Qureshi Stroke Research Center, Min-neapolis, USA2, Hospital Vall D’ Hebron, Barcelona, SPAIN3, University of Cincinnati Aca-demic Health Center, Cincinnati, USA4, State University of New York, Buffalo, USA5, Bichat University Hospital, Paris, FRANCE6, Bichat University Hospital, Paris, FRANCE7, Medical University of South Carolina, Charleston, USA8, State University of New York, Buffalo, USA9, University of Cincinnati Academic Health Center, Cincinnati, USA10, Hospital Vall D’ Hebron, Barcelona, SPAIN11, Zeenat Qureshi Stroke Research Center, Minneapolis, USA12, Bichat Uni-versity Hospital, Paris, FRANCE13 Background : Onset-to-reperfusion time (ORT) has been reported to be associated with clin-ical prognosis. However, its impact on mortality remained to be assessed. Using a collabora-tive- pooled analysis, we examined whether early mortality after successful endovascular treat-ment is time-dependent. Methods: In a collaborative-pooled analysis of 7 endovascular databases, we assessed the im-pact of ORT in large artey occlusion (internal carotid artery (ICA) or middle cerebral artery (MCA) on outcomes. Successful reperfusion was defined as complete or partial restoration of blood flow within 8 hours from symptom onset. Primary outcome was 90 days all-cause mor-tality. Secondary outcomes included 90-day favorable outcome (modified Rankin score (mRS) 0-2), 90-day excellent outcome (mRS 0-1) and occurrence of any intracerebral hemorrhage (ICH) within 24-36 hours post-treatment. Results: 480 cases with successful reperfusion (median time, 285 minutes) contributed to the present pooled analysis (120 with ICA occlusion and 360 with isolated MCA occlusion). In-creasing ORT was associated with an increased rate of mortality and ICH, and was associated with a decreased rate of favorable and excellent outcomes, without heterogeneity across studies. The adjusted odds ratio (95% confidence interval) for each 30-minute time increase was 1•21 (1•09-1•34; p<0.001) for mortality, 0•79 (0•72-0•87) for favorable outcome, 0•78 (0•71-0•86) for excellent outcome, and 1•21 (1•10-1•33) for ICH. Conclusions : ORT impacts mortality as well as favorable outcome and should be considered as the main goal in acute stroke patient management. 158 © 2013 S. Karger AG, Basel Scientific Programme


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