Explore the critical link between LDL-C levels and bleeding risks in patients undergoing DAPT post-minor ischemic stroke or TIA, shedding light on a pivotal aspect of stroke management and prevention.
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LDL-C Levels and Bleeding Risk in Patients Taking DAPT After Minor Ischemic Stroke or TIA.
Cheng et al., JAMA Neurol 2024
<!– DOI: 10.1001/jamaneurol.2024.0086 //–>
https://doi.org/10.1001/jamaneurol.2024.0086
This study investigates the association between low-density lipoprotein cholesterol (LDL-C) levels and bleeding risk in patients with minor ischemic stroke (MIS) or high-risk transient ischemic attack (HRTIA) undergoing dual antiplatelet therapy (DAPT). Analyzing data from two clinical trials in China, the research included 7440 patients, revealing that those with LDL-C levels below 70 mg/dL experienced a higher risk of bleeding. Specifically, the adjusted hazard ratio (aHR) for any bleeding was 1.48, and for severe or moderate bleeding, it was 2.78. Notably, the increased risk of any bleeding was more pronounced in the ticagrelor-aspirin group (aHR, 1.71) compared to the clopidogrel-aspirin group, where the association was not significant. This study highlights the importance of carefully selecting LDL-C target levels and DAPT regimens in patients with MIS or HRTIA to balance the benefits against the risk of bleeding, especially for those on ticagrelor-aspirin therapy.