Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage: Extended Follow-up of the RESTART Randomized Clinical Trial

JAMA Neurology
UK RCT (n=537; median 3-year follow-up), found no difference in recurrent intracerebral haemorrhage (8.2% with antiplatelet therapy [AT] vs 9.3% without AT; adjusted HR, 0.87; 95% CI, 0.49-1.55; P = 0.64) or major vascular events (26.8 vs 32.5%; 0.79; 0.58-1.08; P = 0.14).

Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial

The Lancet Neurology
SoSTART RCT (n=218) did not confirm non-inferiority of starting oral anticoagulation (OAC) vs avoiding OAC for recurrent intracranial haemorrhage: 8% vs 4%; adjusted HR 2.42; 95% CI 0.72–8.09; p=0.152) with no difference in serious adverse events (17% vs 15%).

De-Escalation of Dual Antiplatelet Therapy in Patients WithAcute Coronary Syndromes

Journal of the American College of Cardiology
In analysis (15 RCTs;n=55,798), DAPT with aspirin & de-escalation from standard-dose potent P2Y12inhibitor (ticagrelor or prasugrel[PG]) to clopidogrel or low-dose PG 1 month after PCI was linked to fewer bleeding events vs. other DAPT strategies & no increase in ischaemic events.

Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs

Neurology
Review (3 studies, n=1092) detected no differences in functional outcomes at 3 months with direct endovascular treatment compared to combination of endovascular treatment preceded by IV thrombolysis in patients with an acute large vessel occlusion.

The above records have been identified by UKMi and feature in the NICE Medicines Awareness Service. Further details on this service can be found at:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services