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Abstract Details

High Dose Aspirin Versus Clopidogrel After a Breakthrough Ischemic Event While on Low Dose Aspirin
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)

Recent trials demonstrate that for patients developing a breakthrough IE while on aspirin, addition of or switching to another anti-platelet agent is associated with lower IE recurrence. At our Comprehensive Stroke Center (CSC), many patients who developed a breakthrough IE while on ASA81 were either switched to ASA325 or C75. There is lack of evidence comparing these two strategies.

To compare the rate of recurrence of an ischemic event, IE (ischemic stroke or transient ischemic attack) among patients who were either switched to high dose aspirin (ASA325) or clopidogrel 75 mg (C75) with or without a loading dose, after developing breakthrough IE while on low dose aspirin (ASA81).
A retrospective chart review was performed for admissions at our CSC with IE between January 2013 to August 2018. Inclusion criteria required an index IE while on ASA81 and a switch to ASA325 or C75 at discharge. Patients on dual anti-platelet therapy or therapeutic anticoagulation were excluded. Primary outcome was re-hospitalization due to recurrent IE. Secondary outcomes were bleeding defined by Thrombolysis in Cerebral Infarction Criteria and all-cause mortality within one year of index IE. Fisher’s exact test and Kaplan Meier curves were used. 
Of 963 patients screened, 896 were excluded. 32 patients were included in the ASA325 group and 35 in the C75 group. The groups had similar baseline median age, weight, NIHSS at presentation, and intravenous thrombolysis rate (p>0.1). There were two recurrent IE in ASA325 group and three in C75 (p=1.00). There was one death in ASA325 and none in C75 (p=0.48), as well as one bleed in each group (p=1.00).  Time from discharge to recurrence was similar between groups (p=0.74).
Rates of recurrent IE, time to recurrence, bleeding, and mortality were all similar between patients receiving ASA325 or C75 after experiencing breakthrough IE while on ASA81.
Saurav Das, MD (Washington University in St. Louis)
Dr. Das has nothing to disclose.
No disclosure on file
Shivani Naik, MD (Cedar Sinai Medical Center) Dr. Naik has nothing to disclose.
Chelsey Mcpheeters, PharmD (University of Louisville) No disclosure on file
No disclosure on file
Michael Haboubi, DO (University of Louisville SOM) Dr. Haboubi has nothing to disclose.