Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5th Floor, Providence, RI, 02903, USA.
Neurol Sci. 2023 Aug;44(8):2831-2834. doi: 10.1007/s10072-023-06773-1. Epub 2023 Mar 25.
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is hallmarked by age-dependent accumulation of microangiopathy with antiplatelet medications commonly used for stroke prevention though without known therapeutic benefit. Our objective was to identify whether antiplatelet therapy impacted the incidence of acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in those with reported CADASIL.
Owing to the rarity of the disease, we performed a retrospective study of anonymized data from the international TriNetX Research Network (Oct 2015 through January 2021). Individuals had an ICD-10 code (I67.850) for CADASIL. The primary outcome was incidence of validated ICD-10 codes for AIS (I63) and ICH (I61) linked with unique hospital admission encounters. The primary exposure was use of an antiplatelet medication for at least 1 month prior to the primary outcome. Age-adjusted logistic regression was used for likelihood ratios.
We identified 455 individuals: 36% female, 40 (8.8%) antiplatelet exposed. Those with antiplatelet use were older (antiplatelet: 61±12 years vs. unexposed: 57±14 years, p = 0.034) with similar rates of AIS [antiplatelet: 23%(9/40) vs. unexposed: 14%(60/415); p=0.18] and ICH [antiplatelet: 3%(1/40) vs. unexposed: 5%(19/415); p = 0.54) and without significant impact on age-adjusted AIS likelihood (OR 1.62, 95%CI 0.73-3.60, p=0.23). Sample size precluded ICH regression analyses.
Our data suggests that antiplatelet use did not significantly impact incidence of AIS or ICH within a group of individuals with suspected CADASIL This study highlights the need for further understanding of the pathophysiology of CADASIL to lead to disease modifying treatments.
伴皮质下梗死和白质脑病的常染色体显性脑动脉病（CADASIL）的特征是随着年龄的增长，微血管病不断积累，抗血小板药物常用于预防中风，但没有已知的治疗益处。我们的目的是确定在报告有 CADASIL 的患者中，抗血小板治疗是否会影响急性缺血性中风（AIS）或颅内出血（ICH）的发生率。
由于该疾病罕见，我们对来自国际 TriNetX 研究网络（2015 年 10 月至 2021 年 1 月）的匿名数据进行了回顾性研究。患者具有 CADASIL 的 ICD-10 代码（I67.850）。主要结局是与唯一住院就诊相关的经验证的 ICD-10 代码为 AIS（I63）和 ICH（I61）的发生率。主要暴露是在主要结局之前至少使用 1 个月的抗血小板药物。使用年龄调整的逻辑回归进行可能性比。
我们确定了 455 名患者：女性占 36%，40 名（8.8%）接受抗血小板治疗。使用抗血小板药物的患者年龄更大（抗血小板治疗：61±12 岁，未暴露：57±14 岁，p=0.034），AIS 发生率相似[抗血小板治疗：23%（9/40），未暴露：14%（60/415）；p=0.18]和 ICH [抗血小板治疗：3%（1/40），未暴露：5%（19/415）；p=0.54]，并且对年龄调整的 AIS 可能性没有显著影响（OR 1.62，95%CI 0.73-3.60，p=0.23）。样本量限制了 ICH 回归分析。
我们的数据表明，在一组疑似 CADASIL 的患者中，抗血小板治疗并未显著影响 AIS 或 ICH 的发生率。本研究强调需要进一步了解 CADASIL 的病理生理学，以导致疾病修饰治疗。
