Antiplatelet Therapy for Silent Brain Infarction

NCT ID: NCT03318744

Last Updated: 2017-10-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

3400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-31

Study Completion Date

2021-12-31

Brief Summary

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Silent brain infarction (SBI) or incidental infarct is common. Recent studies revealed individuals with SBI have an increased risk of future stroke. Even though the 2014 AHA/ASA recommendation for ischemic stroke and transient ischemic attack considered SBI as an entry point for secondary prevention, convincing evidence with regard to the preventive efficacy of antiplatelet therapy against incident stroke in SBI is scant. Investigators examine if antiplatelet therapy can effectively decrease the incidence of future stroke in SBI individuals.

Detailed Description

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SBI is defined as a focal hyperintense lesion on T2-weighted images and/or fluid-attenuated inversion recovery with no corresponding symptoms in the clinical history of the patient that could be attributed to the lesion. SBI were distinguished from nonspecific subcortical and periventricular white matter lesions by the presence of a corresponding hypointense lesion on T1-weighted images.

The prevalence of SBI varies from 5% to 62% in healthy population. To date, few studies investigate the association between SBI and ethnicity. The effectiveness of antithrombotics including aspirin against future symptomatic stroke in SBI patients remains to be established. Due to the high prevalence of ICAS among Chinese, and its nature of artery-to-artery microembolisms, investigators hypothesize that the prevalence of SBI among Chinese might be significantly higher than other races such as Caucasians and African-Americans.

Recent study has revealed that SBI is associated with an 2-fold increase of future ischemic stroke. Yet, interventions such as antiplatelet therapies for reducing the stroke risk in SBI patients have not been investigated to our best knowledge. In this study, investigators examine whether regular oral aspirin can reduce the incidence of cerebrovascular events and mortality in SBI patients.

Conditions

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Brain Infarction

Keywords

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Silent Brain Infarction Antithrombotics Antiplatelet Aspirin Asymptomatic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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aspirin 100mg

Participants will be given aspirin 100mg once per day.

Group Type EXPERIMENTAL

Aspirin

Intervention Type DRUG

Aspirin is one of the most widely used antithrombotic agents to prevent recurrent ischemic stroke for patients with prior symptomatic ischemic stroke.

placebo

Participants will be given placebo oral tablets once per day.

Group Type PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type DRUG

Placebo resembling aspirin tablet will be be given to participants in control arm.

Interventions

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Aspirin

Aspirin is one of the most widely used antithrombotic agents to prevent recurrent ischemic stroke for patients with prior symptomatic ischemic stroke.

Intervention Type DRUG

Placebo Oral Tablet

Placebo resembling aspirin tablet will be be given to participants in control arm.

Intervention Type DRUG

Other Intervention Names

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Bayaspirin

Eligibility Criteria

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Inclusion Criteria

* cerebral infarction(s) identified by CT/MRI (≥ 3mm in diameter)
* absence of signs or symptoms of neurological dysfunction ascribed to the lesion(s)
* absence of PMH of neurological dysfunctions due to CNS lesion(s)

Exclusion Criteria

* Age under 45 years or above 80 years
* PMH of ICH within 180 days
* PMH of lobar hemorrhage of anytime
* Neuroimaging evidence suggesting cerebral microbleeds
* High risk of bleeding (e.g. recurrent gastrointestinal or genitourinary bleeding, active peptic ulcer disease)
* Anticipated requirement for long-term use (more than 28 days) of anticoagulants (e.g. recurrent deep vein thrombosis)
* Prior long-term use of anticoagulants (more than 28 days) or antiplatelet agents (more than 28 days)
* Prior retinal stroke/TIA (diagnosed either clinically or by imaging)
* Intolerance or contraindications to aspirin (including thrombocytopenia, prolonged INR)
* Prior ipsilateral carotid endarterectomy/stent
* Stenosis of culprit artery ≥ 70% (detected by ultrasound, MRA, CTA or DSA)
* Atrial fibrillation, or acute myocardial infarction, or acute congestive heart failure
* Impaired renal function: glomerular filtration rate\<60
* Mini Mental Status Examination score\<24 (adjusted for age and education)
* Medical contraindication to MRI
* Pregnancy or women of child-bearing potential who are not following an effective method of contraception
* Unable or unwilling to provide informed consent
* Unlikely to be compliant with therapy/unwilling to return for frequent clinic visits
* Patients concurrently participating in another study with an investigational drug or device
* Independence ascribed to limb deformity or prior disability
* Acute myocardial infarction
* Acute congestive heart failure
* Other anticipated reasons for future application of antiplatelet agents other than aspirin (eg. recent stenting, interventional surgeries, Lower-Extremity Atherosclerotic Arterial Disease etc)
Minimum Eligible Age

45 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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First People's Hospital of Shenyang

OTHER

Sponsor Role lead

Responsible Party

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Dr. Yi Sui

Director of Neurology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yi Sui, MD PhD

Role: PRINCIPAL_INVESTIGATOR

First People's Hospital of Shenyang

Locations

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Shenyang Brain Hsopital

Shenyang, Liaoning, China

Site Status

Countries

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China

Central Contacts

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Yi Sui, MD PhD

Role: CONTACT

Phone: +86 24 31956417

Email: [email protected]

Ying Xiao, MMed

Role: CONTACT

Phone: +86 24 31956417

Email: [email protected]

Facility Contacts

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Yi Sui, MD

Role: primary

Ying Xiao, MMed

Role: backup

References

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Weber R, Weimar C, Wanke I, Moller-Hartmann C, Gizewski ER, Blatchford J, Hermansson K, Demchuk AM, Forsting M, Sacco RL, Saver JL, Warach S, Diener HC, Diehl A; PRoFESS Imaging Substudy Group. Risk of recurrent stroke in patients with silent brain infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) imaging substudy. Stroke. 2012 Feb;43(2):350-5. doi: 10.1161/STROKEAHA.111.631739. Epub 2012 Jan 19.

Reference Type BACKGROUND
PMID: 22267825 (View on PubMed)

Chou CC, Lien LM, Chen WH, Wu MS, Lin SM, Chiu HC, Chiou HY, Bai CH. Adults with late stage 3 chronic kidney disease are at high risk for prevalent silent brain infarction: a population-based study. Stroke. 2011 Aug;42(8):2120-5. doi: 10.1161/STROKEAHA.110.597930. Epub 2011 Jun 23.

Reference Type BACKGROUND
PMID: 21700935 (View on PubMed)

Nakagawa T, Sekizawa K, Nakajoh K, Tanji H, Arai H, Sasaki H. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J Intern Med. 2000 Feb;247(2):255-9. doi: 10.1046/j.1365-2796.2000.00599.x.

Reference Type BACKGROUND
PMID: 10692089 (View on PubMed)

Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, Wang Y, Zou X, Leung TW, Cai Y, Bai Q, Wu Y, Wang C, Pan X, Luo B, Wong KS; CICAS Study Group. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke. 2014 Mar;45(3):663-9. doi: 10.1161/STROKEAHA.113.003508. Epub 2014 Jan 30.

Reference Type BACKGROUND
PMID: 24481975 (View on PubMed)

Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol. 1998 Nov;55(11):1475-82. doi: 10.1001/archneur.55.11.1475.

Reference Type BACKGROUND
PMID: 9823834 (View on PubMed)

Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, Wright C, Beiser AS, Seshadri S, Pandya A, Kamel H. Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis. Stroke. 2016 Mar;47(3):719-25. doi: 10.1161/STROKEAHA.115.011889.

Reference Type BACKGROUND
PMID: 26888534 (View on PubMed)

Smith EE, Saposnik G, Biessels GJ, Doubal FN, Fornage M, Gorelick PB, Greenberg SM, Higashida RT, Kasner SE, Seshadri S; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; and Council on Hypertension. Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Feb;48(2):e44-e71. doi: 10.1161/STR.0000000000000116. Epub 2016 Dec 15.

Reference Type BACKGROUND
PMID: 27980126 (View on PubMed)

Other Identifiers

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FirstPHShenyang

Identifier Type: -

Identifier Source: org_study_id