Abstract 12765: Meta-Analysis of Secondary Prevention of Cryptogenic Stroke

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12765-A12765
• Main Authors: Kheiri, Babikir, Golwala, Harsh, Osman, Mohammed, Dalouk, Khidir, Stecker, Eric, Zahr, Firas, Nazer, Babak, Rahmouni, Hind W
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.12765

IntroductionCryptogenic stroke and embolic stroke of undetermined source (ESUS) represent a subtype of ischemic stroke with an uncertain cause. The best anti-thrombotic therapy in this population is uncertain.MethodsElectronic databases search was performed for all randomized controlled trials (RCTs) that evaluated anti-thrombotic therapy in cryptogenic stroke and/or ESUS. The primary outcome was recurrent ischemic stroke. Secondary outcomes included transient ischemic attack (TIA), any death, major bleeding, and intracranial bleeding. Direct frequentist random-effect meta-analysis using the DerSimonian and Laird model was performed. Data were reported as hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsEight RCTs with a total of 16,092 patients randomizing 22,497 patient-years of follow-up (mean age 62.0 ± 13.2 and 60.8% male) were included. Compared with antiplatelet therapy, anticoagulation therapy was associated with a significantly reduced recurrent ischemic stroke (HR=0.66; 95% CI=0.47-0.94; P=0.026). Meta-regression analysis showed significantly reduced recurrent strokes with longer follow-up duration, and significantly higher events with advanced age. Significant interactions were observed based on the presence of patent foramen ovale (present vs absent), stroke subtypes (cryptogenic vs ESUS), and anticoagulant types (vitamin-K-antagonists vs direct oral anticoagulants). There were no significant differences with regard to the secondary outcomes between both therapies.ConclusionsAmong patients with cryptogenic stroke or ESUS, anticoagulation therapy is associated with lower recurrent strokes without increased bleeding risks compared with antiplatelet therapy.