Key result
Young adults surviving a first-ever ischemic stroke or TIA had a 10-year cumulative risk of any bleeding of 21.8%, which was significantly higher in women than men (28.2% vs 13.7%; P<0.01).
Why the study?
Antithrombotic recommendations for secondary prevention in young patients with ischemic stroke or TIA are based on trials in older patients, leaving long-term bleeding and ischemic risks in young patients uncertain.
Cohort (n=544)
Young adults surviving a first-ever ischemic stroke or TIA face a substantial long-term risk of both bleeding (especially women) and recurrent ischemic events, highlighting the need to balance antithrombotic therapy risks and benefits.
Substantial long-term bleeding and ischemic risks persist in young stroke/TIA survivors; leaves open optimal antithrombotic regimens.
Background and Objectives Guidelines recommend antithrombotic medication as secondary prevention for patients with ischemic stroke or transient ischemic attack (TIA) at young age based on results from trials in older patients. We investigated the long-term risk of bleeding and ischemic events in young patients after ischemic stroke or TIA. Methods We included 30-day survivors of first-ever ischemic stroke or TIA aged 18–50 years from the Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, a prospective cohort study of stroke at young age. We obtained information on recurrent ischemia based on structured data collection from 1995 until 2014 as part of the FUTURE study follow-up, complemented with information on any bleeding and ischemic events by retrospective chart review from baseline until last medical consultation or June 2020. Primary outcome was any bleeding; secondary outcome any ischemic event during follow-up. Both were stratified for sex, age, etiology, and use of antithrombotic medication at discharge. Bleeding and ischemic events were classified according to location and bleeding events also by severity. Results We included 544 patients (56.1% women, median age of 42.2; interquartile range [IQR] 36.5–46.7 years) with a median follow-up of 9.6 (IQR 2.5–14.3) years. Ten-year cumulative risk of any bleeding event was 21.8% (95% CI 17.4–26.0) and 33.9% (95% CI 28.3–37.5) of any ischemic event. Risk of bleeding was higher in women with a cumulative risk of 28.2% (95% CI 21.6–34.3) vs 13.7% (95% CI 8.2–18.9) in men (p < 0.01), mainly because of gynecologic bleeds. Female sex (p < 0.001) and age between 40 and 49 years (p = 0.04) were independent predictors of bleeding. Discussion Young patients after ischemic stroke or TIA have a substantial long-term risk of both bleeding (especially women) and ischemic events. Future studies should investigate the effects of long-term antithrombotics in young patients, taking into account the risk of bleeding complications.
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Verhoeven et al. (2022) conducted a cohort in Ischemic stroke or TIA (n=544). First-ever ischemic stroke or TIA was evaluated on any bleeding (95% CI 17.4-26.0). Young adults surviving a first-ever ischemic stroke or TIA had a 10-year cumulative risk of any bleeding of 21.8%, which was significantly higher in women than men (28.2% vs 13.7%; P<0.01).
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