Evidence map›Paper›PMID 29374102›Full record

SynthesisNeurology2018

Early time course of major bleeding on antiplatelet therapy after TIA or ischemic stroke.

Nina A Hilkens, Ale Algra, L Jaap Kappelle, Philip M Bath, László Csiba, Peter M Rothwell, Jacoba P Greving, CAT Collaboration

Open access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
3.8field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.

  1. Pooled it
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  15. Clinical perspectives on ischemic stroke.Experimental neurology · 2021
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

Nina A HilkensFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK. n.a.hilkens-3@umcutrecht.nl.
Ale AlgraFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
L Jaap KappelleFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
Philip M BathFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
László CsibaFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
Peter M RothwellFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
Jacoba P GrevingFrom the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery (A.A., L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Stroke Trials Unit (P.M.B.), Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology (L.C.), University of Debrecen Medical and Health Science Center, Hungary; and Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
CAT Collaboration
University of Nottingham · GBUniversity of Debrecen · HU

Funding

Department of Health 10/104/24
6 · The paper itself

Abstract

objectiveTo study the early time course of major bleeding and its subtypes in patients with cerebral ischemia on dual and single antiplatelet therapy.

methodsWe performed a post hoc analysis on individual patient data from 6 randomized clinical trials (Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events [CAPRIE], Second European Stroke Prevention Study [ESPS-2], Management of Atherothrombosis With Clopidogrel in High-Risk Patients [MATCH], Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance [CHARISMA], European/Australasian Stroke Prevention in Reversible Ischaemia Trial [ESPRIT], and Prevention Regimen for Effectively Avoiding Second Strokes [PRoFESS]) including 45,195 patients with a TIA or noncardioembolic ischemic stroke. We studied incidence rates of bleeding per antiplatelet regimen stratified by time from randomization (≤30, 31-90, 91-180, 181-365, >365 days). We calculated incidence rates per trial and pooled estimates with random-effects meta-analysis. We performed Poisson regression to assess differences between time periods with adjustment for age and sex.

resultsThe incidence of major bleeding on aspirin plus clopidogrel and aspirin plus -dipyridamole was highest in the first 30 days, 5.8 and 4.9 per 100 person-years, respectively, and was significantly higher than at 31 to 90 days (rate ratio 1.98, 95% confidence interval 1.16-3.40 for aspirin plus clopidogrel; rate ratio 1.94, 95% confidence interval 1.24-3.03 for aspirin plus dipyridamole). Incidence rates on aspirin and clopidogrel monotherapy were 2.8 and 2.5 per 100 person-years, respectively, in the first 30 days, with no significant change over time. The time course was similar for gastrointestinal bleeds. There was no early excess of intracranial hemorrhage in patients on either dual or single antiplatelet therapy.

conclusionDual antiplatelet therapy is associated with high early risks of major and gastrointestinal bleeding that decline after the first month in trial cohorts.

Indexed as

AgedBrain IschemiaDrug Therapy, CombinationFemaleHemorrhageHumansIncidenceMalePlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicStrokeTime FactorsPlatelet Aggregation Inhibitors

Identifiers

PMID29374102
PMCPMC5818163
OpenAlexW2785279414

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.