Peripheral artery disease increases risk of Stroke and TIA: EUCLID clinical trial

Delhi: Patients with symptomatic peripheral artery disease (PAD) are at increased risk of stroke and transient ischemic attack (TIA), according to findings from the EUCLID clinical trial. The study, published in the AHA journal Stroke, further found that the use of ticagrelor relative to clopidogrel was associated with a lower adjusted rate of ischemic and all-cause stroke.

Stroke impacts millions of people worldwide and is the leading cause of long-term disability. Treatment with antiplatelet agents is the present best practice in all cardiovascular patients without known atrial fibrillation (AF), including those with reduced peripheral artery illness and previous stroke, to avoid ischemic stroke. However, in setting PAD, the rates if stroke and main risk factors for stroke are not well researched and may involve an alternative avoidance strategy.

Brad J. Kolls, From the Department of Neurology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, and colleagues conducted the study to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients.

In the study, 13 885 patients with symptomatic PAD were randomized to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates post-randomization and cumulative incidence (per patient-years).

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Key findings of the study include:

• A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively.


• Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index <0.60, prior amputation, and systolic blood pressure were independent baseline factors associated with the occurrence of all-cause stroke.


• After adjustment for baseline factors, the rates of ischemic stroke and all-cause stroke remained lower in patients treated with ticagrelor as compared with those receiving clopidogrel.


• There was no significant difference in the incidence of hemorrhagic stroke or TIA between the 2 treatment groups.

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"Further study is needed to optimize medical management and risk reduction of all-cause stroke in patients with PAD," concluded the authors.

To read the complete study log on to https://doi.org/10.1161/STROKEAHA.118.023534