Abstract Details

Title Amino Terminal Pro-B-Type Natriuretic Peptide, Secondary Stroke Prevention, and Choice of Antithrombotic Therapy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S41 - (-)

Poster/Presentation
Number 003

Objective

Background The Warfarin-Aspirin Recurrent Stroke Study (WARSS) is a previously reported randomized, blinded trial of warfarin versus aspirin therapy among patients with inferred non-cardioembolic ischemic strokes. We hypothesized that NT-proBNP would identify a subgroup of patients in whom relative efficacy of warfarin and aspirin would be modified by NT-proBNP concentrations.

Design/Methods NT-proBNP was measured in stored serum collected at baseline from a subset of participants enrolled in the Antiphospholipid Antibodies and Stroke Study (APASS)-WARSS collaboration. Relative effectiveness of warfarin and aspirin in preventing recurrent ischemic stroke or death over two years was compared based on NT-proBNP concentrations.

Results About 95% of 1028 patients with assays had NT-proBNP ?750 pg/mL, and among them, no evidence for treatment effect modification was apparent. For 49 patients with NT-proBNP >750 pg/mL, the two-year rate of events per 100 person-years was 45.9 for the aspirin group and 16.6 for the warfarin group, while 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 0.31 (95% confidence interval 0.12-0.84, p-value=0.021) significantly favoring warfarin over aspirin. A formal test for interaction of NT-proBNP with treatment was significant (p-value=0.01).

Conclusions For secondary stroke prevention, elevated NT-proBNP concentrations may identify a subgroup of ischemic stroke patients without known atrial fibrillation, about 5% in this study, who may benefit more from anticoagulants than antiplatelet agents. Replication of these results is needed before NT-proBNP can be considered for guiding decisions about antithrombotic therapy in this clinical setting.

Authors/Disclosures
Mitchell S. Elkind, MD, MS, FAAN PRESENTER	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
	No disclosure on file
W. T. Longstreth, Jr., MD, FAAN (Harborview Medical Center)	The institution of Dr. Longstreth has received research support from NIH.
	No disclosure on file
John L. Thompson, PhD (Columbia Univ School of Public Health)	The institution of Dr. Thompson has received research support from NIH.
	No disclosure on file
Steven Levine, MD, FAHA (SUNY Downstate Medical Center)	Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.
	No disclosure on file
Robin L. Brey, MD (Univ of TX Hlth Science Ctr/MSC 7883)	The institution of Dr. Brey has received research support from State of Texas. Dr. Brey has a non-compensated relationship as a Task Force Member with AAN that is relevant to AAN interests or activities.
Richard Buchsbaum	No disclosure on file
David L. Tirschwell, MD, FAAN (Harborview Medical Center)	Dr. Tirschwell has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for CARMAT. Dr. Tirschwell has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AbbVie. The institution of Dr. Tirschwell has received research support from Abbott. The institution of Dr. Tirschwell has received research support from NIH.
	No disclosure on file
J. P. Mohr, MD, FAAN (Neurological Institute)	The institution of Dr. Mohr has received research support from NINDS Grant R01 NS099268 NIH-NINDS .
	No disclosure on file

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