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TOPLINE:

Low low-density lipoprotein (LDL) cholesterol is associated with an increased risk of bleeding within 3 months of a major ischemic stroke (MIS) or high-risk transient ischemic attack (HRTIA) in patients receiving treatment with dual antiplatelet therapy (DAPT), especially ticagrelor and aspirin, a new study suggested.

METHODOLOGY:

• Investigators analyzed pooled data from two randomized, double-blind, placebo-controlled clinical trials in China of patients with MIS or HRTIA who were receiving DAPT.
• Patients (n = 7440, median age, 64 years; 33% female) were receiving clopidogrel and aspirin (n = 4486) or ticagrelor and aspirin (n = 2954).
• Patients were followed for up to 90 days.

TAKEAWAY:

• At 3 months after stroke, a total of 270 (3.63%) bleeding events were reported, of which 5.16% occurred in those with LDL < 70 mg/dL and 3.46% in patients with LDL ≥ 70 mg/dL.
• An LDL level of < 70 mg/dL was associated with an increased risk of any bleeding (adjusted hazard ratio [aHR], 1.48; P = .03) and severe or moderate bleeding (aHR, 2.78; P = .02).
• In particular, the risk of any bleeding was increased at lower LDL cholesterol levels in the ticagrelor-aspirin group (aHR, 1.71; P = .02), but not in the clopidogrel-aspirin group (aHR, 1.30; P = .38).

IN PRACTICE:

"Weighing the risks and benefits is crucial when simultaneously considering the selection of LDL-C target strategies and DAPT regimens among these patients," the authors wrote.

SOURCE:

Jie Xu, MD, PhD, of the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, was the corresponding author of the study, and Aichun Chen, MD, affiliated with the same institution, was the lead author. The study was published online on March 4 in JAMA Neurology.

LIMITATIONS:

Differences between the two trials could have introduced bias. Only baseline LDL cholesterol levels were obtained. Although this study had a large sample size, the number of intracranial hemorrhage events available for assessing associated risk factors was limited. Finally, patients were all from China, and bleeding risk is known to be higher in East Asian vs White individuals receiving antithrombotic therapies.

DISCLOSURES:

This work was supported by the National Key R&D Program of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, and the National Natural Science Foundation of China. The authors reported no relevant financial relationships.