Year: 2018
Type: editorial
Abstract: See related article, p 601Secondary ischemic stroke prevention requires navigating a strait with infarction on one side and hemorrhage on the other.With increasing age, the strait gets narrower and the rocks sharper.It helps to have good navigational charts and Hilkens et al 1 provide one with their validation study of the S 2 TOP-BLEED scale published in this journal.Clinical scores are published regularly, derived from observational studies and simplified with a limited number of inputs, all with the goal of being able to predict some future adverse outcome in patients.It is not clear whether the derivation of a scale, regardless of its convenience, is sufficient, because a major question for any scale is how well it performs across diverse populations.This study performs an important but often neglected task by validating 3 scales to estimate risk of bleeding on antiplatelet drugs after a transient ischemic attack or ischemic stroke.The authors used a cohort of stroke and transient ischemic attack patients treated with antiplatelet medication from the population-based Oxford Vascular Study to externally validate the S 2 TOP-BLEED scale for major bleeding.The scale scored a modest C statistics of 0.69, which nevertheless was better than the performance of competing scales (REACH, C statistics of 0.63, and Intracranial-B2LEED3S, 0.60) in the same cohort.Rising age, which demonstrates a nonlinear increase in risk, was the most important part of every model, and the S 2 TOP-BLEED scale represented risk from advanced age particularly well.Performance for lethal bleeding was especially good at 0.77 and the ratio of infarction to major bleeding, mostly from the gastrointestinal tract, decreased from 6.6 in the lowest risk group to 1.8 in the highest risk group, making the score particularly relevant in the most vulnerable patients.The patients at highest risk for bleeding, however, also had the highest risk of recurrent ischemic stroke.This report highlights how antiplatelet treatment, though beneficial for recurrent ischemic stroke prevention, comes at a price.It is not as purely good as eating vegetables.
Source: Stroke
Authors: Daniel L. Labovitz, Mandip S. Dhamoon
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2793235258