Patients with stroke/TIA are prone to developing a recurrent vascular event.

Between August 2012 and June 2015, consecutive patients with ischemic stroke were recruited from the National University Hospital, Singapore. Information on demographic, risk factor, stroke etiology and severity, and medication compliance were collected, and a panel of blood biomarkers was measured. Primary endpoint was the time to first occurrence to a composite of vascular events (stroke/TIA, myocardial infarction and vascular-related death). To investigate whether the lack of platelet inhibition could explain the association between antiplatelet use and recurrent vascular events, platelet Cox-1 levels were measured in aspirin-treated patients. Cox proportional hazard model was used to derive unadjusted and adjusted hazard ratios (95% confidence interval) with statistical significance set at p<0.05.

A total of 305 ischemic stroke patients (mean age 62.6 ± 12.6 years; 66% men) were recruited and followed for a mean of 3.6±1.8 years; 34 vascular events (20 stroke/TIA and 14 coronary artery events) were recorded. Prior diagnosis of CAD and antiplatelet use at the time of stroke were found to be significant predictors of recurrent vascular events on stepwise regression analysis (adjusted HR, 2.63, 1.64-4.24, and 1.24, 0.77-2.01, respectively). Pro-brain natriuretic peptide levels (>121 pg/ml) predicted the recurrent vascular events (HR 2.02, 1.27-3.20); no relationship was observed with high-sensitivity C-reactive protein, interleukin-6, cortisol, neuron-specific enolase and S100β. Among aspirin-treated patients, the extent of Cox-1 inhibition was not associated with recurrent vascular events.