Effect Of Blood Lipid Profile On Bleeding After Antiplatelet Therapy In Patients With Acute Minor Stroke Or TIA

Background and Purpose: China is the country with the largest burden of cerebrovascular disease.Stroke has become the first leading cause of mortality for residents.Acute minor stroke/TIA is the most common and unstable acute cerebrovascular disease,which has the best timing for early warning and prevention.In the latest domestic and international guidelines for stroke treatment,short-term combination with clopidogrel and aspirin are recommended to reduce the risk of recurrence in patients with acute minor stroke/high-risk TIA within 24 hours of onset.However,the combination of antiplatelet therapy increases the risk of potential bleeding and largely limits its clinical application.How to accurately assess the risk of bleeding is a critical clinical problem that needs to be resolved.Meta-analysis of the cohort of healthy individuals showed that abnormal blood lipid levels significantly affected the risk of developing hemorrhagic stroke;small sample imaging studies from patients showed that a decrease in total cholesterol or an increase in high-density lipoprotein cholesterol increased the risk of intracranial microbleeds.However,the effect of blood lipid levels on the risk of bleeding after antiplatelet therapy in stroke patients remains unclear.The aim of this study was to evaluate the effect of blood lipid levels on bleeding risk in patients with acute minor stroke/high-risk TIA treated with antiplatelet therapy.Methods: This study included a total of 3044 patients with acute minor stroke/high-risk TIA available with a blood sample in the trial of "the clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events(CHANCE)".Acute minor stroke/high-risk TIA patients within 24 hours of onset were randomly divided into two groups: aspirin combined with clopidogrel and aspirin monotherapy.We measured levels of total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol and triglyceride,which are common in clinical practice.The primary end point was any bleeding within 90 days.The secondary endpoint event was severe bleeding as defined by GUSTO.Cox proportional hazards model was used to analyze the effect of blood lipids on bleeding and to explore the interactions between other factors and lipids.Results: A total of 59(1.9%)any bleeding events and 30 severe bleeding events occurred at 90 days.High density lipoprotein cholesterol(adjusted hazard ratio,2.16;95% confidence interval,1.17-4.00,per 1 mmol/L increase;P=0.014)and age(adjusted hazard ratio,1.04;95% confidence interval,1.01-1.06,per 1 year increase;P=0.006)were significantly associated with any bleeding.High density lipoprotein cholesterol was also associated with severe bleeding(adjusted hazard ratio,3.05;95% confidence interval,1.39-6.68,per 1 mmol/L increase).Antiplatelet therapy did not interact with any bleeding(P=0.43)or severe bleeding(P=0.92)with high HDL-C patients.No correlations between any bleeding/severe bleeding and levels of total cholesterol,low density lipoprotein cholesterol and triglyceride were found.Conclusions: Higher high density lipoprotein cholesterol level was independently associated with any bleeding and severe bleeding in the patients with acute minor stroke or high-risk TIA on antiplatelet therapy.