Abstract T P336: Risk of Stroke and Vascular Events and Response to Antiplatelet Therapy in Young Adults with Recent Lacunar Strokes: The SPS3 Study

Abstract

Background: Incidence of lacunar strokes increases with age. Young stroke adults have better survival rate, but due to longer life expectancy they are at higher risk of stroke recurrence. Objective: The aim of this study was to examine stroke recurrence and major vascular events in young adults with lacunar strokes, and to explore the effectiveness of antiplatelet therapy for secondary stroke prevention among participants in the Secondary Prevention Small Subcortical Stroke trial (SPS3). Methods: The SPS3 study was a double blind, multicenter secondary stroke prevention trial for patients with symptomatic lacunar infarcts. It evaluated the use of antiplatelets (aspirin+clopidrogel vs aspirin) for stroke prevention. Outcomes were ischemic strokes (IS), hemorrhagic strokes (ICH), major vascular events (MVE), and deaths. Univariate analyses were used to compare the frequency rates of these events among young (<50 yrs) and older adults (50+yrs). Interactions between the outcomes and antiplatelet therapy based on age were also examined. Results: Of 3020 patients, 323 (11%) were <50 year old (mean age 46, 67% M). Mean follow-up was 3.4 years. There were no differences on risk of ischemic stroke recurrence or MVE in two groups. The younger group had a 4-fold reduced risk of death (p<0.001) and significantly lower risk of ICH (p=0.03). There was an interaction between age and antiplatelet therapy for all strokes (p=0.02), IS (p=0.04) and MVE (0.01). The young group in the aspirin+clopidogrel arm had lower risk of all strokes (HR=0.51;95%CI:0.25-1.04.p=0.06), of ischemic strokes (HR=0.62;95%CI:0.30-1.27,p=0.2) and of major vascular events (HR=0.45;95%CI:0.23-0.88,p=0.02). Conclusion: In this exploratory analysis, dual antiplatelet therapy with aspirin+clopidogrel significantly reduced the risk of all strokes, major vascular events and deaths among young adults with recent lacunar strokes. The risk of bleeding was not increased. Response to antiplatelet therapy in young adults with stroke may differ from that in older adults, thus our results deserve further investigations.