{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:58:16Z","timestamp":1790834296073,"version":"4.1.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this cohort study, we enrolled patients with imaging-confirmed ischaemic stroke from the Swiss Stroke Registry (01\/2014-07\/2022). We determined the frequency of prior APT, assessed stroke aetiology (modified TOAST classification) and determined the association of prior APT with unfavourable functional outcome (modified Rankin Scale score 3\u20136) and recurrent ischaemic stroke at 3\u2009months using regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 53,352 patients, 27,484 (51.5%) had no prior antithrombotic treatment, 17,760 (33.3%) were on APT, 7039 (13.2%) on anticoagulation and 1069 (2.0%) were on APT\u2009+\u2009anticoagulation. In patients with a history of ischaemic stroke\/TIA (n\u2009=\u200911,948; 22.4%), 2401 (20.1%) had no prior antithrombotic therapy, 6594 (55.2%) were on APT, 2489 (20.8%) on anticoagulation and 464 (3.9%) on APT\u2009+\u2009anticoagulation. Amongst patients with ischaemic stroke despite APT, aetiology was large artery atherosclerosis in 19.8% (n\u2009=\u20093416), cardiac embolism in 23.6% (n\u2009=\u20094059), small vessel disease in 11.7% (n\u2009=\u20092011), other causes in 7.4% (n\u2009=\u20091267), more than one cause in 6.3% (n\u2009=\u20091078) and unknown cause in 31.3% (n\u2009=\u20095388). Prior APT was not independently associated with unfavourable outcome (aOR\u2009=\u20091.06; 95% CI: 0.98\u20131.14; p\u2009=\u20090.135) or death (aOR\u2009=\u20091.10; 95% CI: 0.99\u20131.21; p\u2009=\u20090.059) at 3-months but with increased odds of recurrent stroke (6.0% vs 4.3%; aOR 1.26; 95% CI: 1.11\u20131.44; p\u2009&amp;lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>One-third of ischaemic strokes occurred despite APT and 20% of patients with a history of ischaemic stroke had no antithrombotic therapy when having stroke recurrence. Aetiology of breakthrough strokes despite APT is heterogeneous and these patients are at increased risk of recurrent stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873231174942","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T04:00:22Z","timestamp":1684900822000},"page":"692-702","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Ischaemic stroke despite antiplatelet therapy: Causes and outcomes"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5431-422X","authenticated-orcid":false,"given":"Norbert","family":"Silimon","sequence":"first","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-6834","authenticated-orcid":false,"given":"Boudewijn","family":"Drop","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leander","family":"Cl\u00e9nin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krassen","family":"Nedeltchev","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"},{"name":"Department of Neurology, Cantonal Hospital of Aarau, Aarau, Switzerland 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-6376","authenticated-orcid":false,"given":"Timo","family":"Kahles","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cantonal Hospital of Aarau, Aarau, Switzerland 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A","family":"Tarnutzer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cantonal Hospital of Baden, Baden, Switzerland 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Katan","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Bonati","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland 4"},{"name":"Reha Rheinfelden, Rheinfelden, Switzerland 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Salmen","sequence":"additional","affiliation":[{"name":"Stroke Unit, Spitalzentrum Biel, Biel, Switzerland 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvan","family":"Albert","sequence":"additional","affiliation":[{"name":"Stroke Unit, Cantonal Hospital Graub\u00fcnden, Chur, Switzerland 7"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Salerno","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland 8"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Carrera","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pitaux Universitaires de Gen\u00e8ve, Geneva, Switzerland 9"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Berger","sequence":"additional","affiliation":[{"name":"Stroke Unit, Cantonal Hospital Grabs, Switzerland 10"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Peters","sequence":"additional","affiliation":[{"name":"Stroke Center, Klinik Hirslanden, Z\u00fcrich, Switzerland 11"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Medlin","sequence":"additional","affiliation":[{"name":"Stroke Unit, Cantonal Hospital Fribourg, Fribourg, Switzerland 12"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Cereda","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland 13"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Bolognese","sequence":"additional","affiliation":[{"name":"Neurocenter, Cantonal Hospital of Lucerne, Lucerne, Switzerland 14"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"K\u00e4gi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"},{"name":"Department of Neurology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland 15"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Renaud","sequence":"additional","affiliation":[{"name":"Neurology and Stroke Unit, Neuch\u00e2tel Hospital Network, Neuch\u00e2tel, Switzerland 16"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Niederhauser","sequence":"additional","affiliation":[{"name":"Stroke Unit, Groupement hospitalier de l\u2019ouest l\u00e9manique, Nyon, Switzerland 17"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bonvin","sequence":"additional","affiliation":[{"name":"Stroke Unit, H\u00f4pital du Valais, Sion, Switzerland 18"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sch\u00e4rer","sequence":"additional","affiliation":[{"name":"Stroke Unit, B\u00fcrgerspital Solothurn, Solothurn, Switzerland 19"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Luise","family":"Mono","sequence":"additional","affiliation":[{"name":"Stroke Unit, Stadtspital Triemli, Zurich, Switzerland 20"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Luft","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Zurich, Zurich, Switzerland 21"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biljana","family":"Rodic-Tatic","sequence":"additional","affiliation":[{"name":"Stroke Unit, Cantonal Hospital Winterthur, Winterthur, Switzerland 22"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"},{"name":"Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland 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