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Amino terminal pro-B-type natriuretic peptide, secondary stroke prevention, and choice of antithrombotic therapy.
- Source :
-
Stroke [Stroke] 2013 Mar; Vol. 44 (3), pp. 714-9. Date of Electronic Publication: 2013 Jan 22. - Publication Year :
- 2013
-
Abstract
- Background and Purpose: Because of its association with atrial fibrillation and heart failure, we hypothesized that amino terminal pro-B-type natriuretic peptide (NT-proBNP) would identify a subgroup of patients from the Warfarin-Aspirin Recurrent Stroke Study, diagnosed with inferred noncardioembolic ischemic strokes, where anticoagulation would be more effective than antiplatelet agents in reducing risk of subsequent events.<br />Methods: NT-proBNP was measured in stored serum collected at baseline from participants enrolled in Warfarin-Aspirin Recurrent Stroke Study, a previously reported randomized trial. Relative effectiveness of warfarin and aspirin in preventing recurrent ischemic stroke or death over 2 years was compared based on NT-proBNP concentrations.<br />Results: About 95% of 1028 patients with assays had NT-proBNP below 750 pg/mL, and among them, no evidence for treatment effect modification was evident. For 49 patients with NT-proBNP >750 pg/mL, the 2-year rate of events per 100 person-years was 45.9 for the aspirin group and 16.6 for the warfarin group, whereas for 979 patients with NT-proBNP ≤750 pg/mL, rates were similar for both treatments. For those with NT-proBNP >750 pg/mL, the hazard ratio was 0.30 (95% confidence interval: 0.12-0.84; P=0.021) significantly favoring warfarin over aspirin. A formal test for interaction of NT-proBNP with treatment was significant (P=0.01).<br />Conclusions: For secondary stroke prevention, elevated NT-proBNP concentrations may identify a subgroup of ischemic stroke patients without known atrial fibrillation, about 5% based on the current study, who may benefit more from anticoagulants than antiplatelet agents. Clinical Trial Registration- This trial was not registered because enrollment began before 2005.
- Subjects :
- Aged
Anticoagulants therapeutic use
Biomarkers blood
Double-Blind Method
Female
Follow-Up Studies
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors therapeutic use
Secondary Prevention
Stroke blood
Treatment Outcome
Aspirin therapeutic use
Natriuretic Peptide, Brain blood
Peptide Fragments blood
Stroke prevention & control
Warfarin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 44
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 23339958
- Full Text :
- https://doi.org/10.1161/STROKEAHA.112.675942