Abstract T P336: Risk of Stroke and Vascular Events and Response to Antiplatelet Therapy in Young Adults with Recent Lacunar Strokes: The SPS3 Study
Bibliographic record
Abstract
Background: Incidence of lacunar strokes increases with age. Young stroke adults have better survival rate, but due to longer life expectancy they are at higher risk of stroke recurrence. Objective: The aim of this study was to examine stroke recurrence and major vascular events in young adults with lacunar strokes, and to explore the effectiveness of antiplatelet therapy for secondary stroke prevention among participants in the Secondary Prevention Small Subcortical Stroke trial (SPS3). Methods: The SPS3 study was a double blind, multicenter secondary stroke prevention trial for patients with symptomatic lacunar infarcts. It evaluated the use of antiplatelets (aspirin+clopidrogel vs aspirin) for stroke prevention. Outcomes were ischemic strokes (IS), hemorrhagic strokes (ICH), major vascular events (MVE), and deaths. Univariate analyses were used to compare the frequency rates of these events among young (<50 yrs) and older adults (50+yrs). Interactions between the outcomes and antiplatelet therapy based on age were also examined. Results: Of 3020 patients, 323 (11%) were <50 year old (mean age 46, 67% M). Mean follow-up was 3.4 years. There were no differences on risk of ischemic stroke recurrence or MVE in two groups. The younger group had a 4-fold reduced risk of death (p<0.001) and significantly lower risk of ICH (p=0.03). There was an interaction between age and antiplatelet therapy for all strokes (p=0.02), IS (p=0.04) and MVE (0.01). The young group in the aspirin+clopidogrel arm had lower risk of all strokes (HR=0.51;95%CI:0.25-1.04.p=0.06), of ischemic strokes (HR=0.62;95%CI:0.30-1.27,p=0.2) and of major vascular events (HR=0.45;95%CI:0.23-0.88,p=0.02). Conclusion: In this exploratory analysis, dual antiplatelet therapy with aspirin+clopidogrel significantly reduced the risk of all strokes, major vascular events and deaths among young adults with recent lacunar strokes. The risk of bleeding was not increased. Response to antiplatelet therapy in young adults with stroke may differ from that in older adults, thus our results deserve further investigations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".