Abstract TP163: Antiplatelet Use And CADASIL: A Multicenter Analysis Of The Trinetx Research Database

Abstract

Introduction: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is hallmarked by a mutation in the NOTCH3 receptor resulting in impaired cerebrovascular autoregulation with subsequent vessel fragility and progressive accumulation of cerebral small vessel disease (CSVD). Antiplatelet medications are commonly prescribed for secondary stroke prevention though this is of unknown therapeutic benefit in preventing acute ischemic stroke (AIS). We aimed to identify whether antiplatelet therapy reduced incidence of AIS in those with reported CADASIL. Methods: Data was collected through the TriNetX Research Network database. Those included were adults with the ICD-10 code (I67.850) for CADASIL. The primary outcome was the validated ICD-10 code for AIS (I63) which were linked with hospital admission encounters. Demographic data and medication use was recorded. The primary exposure was use of an antiplatelet medication for at least 1 month prior to admission for AIS. Standard descriptive and regression analyses were used. Results: Our cohort included 455 individuals: mean age 57±14 years, 36% being female and with similar rates of vascular risk factors between the groups. The antiplatelet cohort was older (antiplatelet: 61 ± 12 yrs vs. unexposed: 57±14 yrs, p = 0.034) and included 40 (8.8%) participants. Rate of AIS trended higher in the antiplatelet group but was not significantly different (antiplatelet: 23%, 9/40 vs. unexposed: 14%, 60/415; p=0.18). Age adjusted logistic regression showed higher odds of AIS (OR 1.62, 95%CI 0.73 - 3.60, p = 0.23). Conclusions: In this hypothesis generating study, our data suggests that antiplatelet use did not significantly impact incidence of AIS. It is unclear if the likelihood findings are related to the natural history of the disease, though this model accounted for differences in age. Further studies are needed to improve power for robust statistical analysis to confirm or refute our findings.