title: Types of stroke recurrence in patients with ischemic stroke: a substudy from the PRoFESS trial.
abstract: BACKGROUND
  Risk profiles for stroke recurrence are poorly characterized.
  
  
  OBJECTIVE
  We determined the variation in the risk and type of recurrent stroke among index ischemic stroke subtypes, and whether index stroke subtype and conventional stroke risk factors were predictors of stroke recurrence.
  
  
  METHODS
  Patients enrolled in the Prevention Regimen for Effectively Avoiding Second Strokes trial were included in this study.
  
  
  RESULTS
  In 1794 patients' recurrent stroke subtypes were the same as the index stroke in: 48·3% of patients with large artery atherothrombosis stroke; 50% of patients with cardioembolic stroke; 48·7% of patients with small artery occlusion stroke; 8·1% of patients with stroke of other etiology, and 45·3% of patients with undetermined etiology stroke. Patients with cardioembolic stroke, who were unwilling or unable to take oral anticoagulants, had the greatest risk of stroke recurrence. Predictors of stroke recurrence in multivariable analysis were: older age and previous stroke among large artery atherothrombosis strokes; older age, male sex, previous stroke, previous transient ischemic attack, hypertension, diabetes, and tobacco use among small artery occlusion strokes; older age among cardioembolic strokes; atrial fibrillation and anti-diabetic medications among other etiology strokes; older age, previous stroke and atrial fibrillation among undetermined etiology strokes. Predictors of brain hemorrhage as recurrent stroke were index small artery occlusion stroke, older age, previous stroke, and antiplatelet treatment with aspirin plus extended-release dipyridamole.
  
  
  CONCLUSIONS
  Risk predictors for stroke recurrence and for brain hemorrhage differ by index ischemic stroke subtype, information that is important when initiating secondary prevention therapy.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Di Mascio
authors.forename: Richard
authors.initials: R
authors.lastname: Vinisko
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012008:Recurrence; D012306:Risk; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
keywords: ischemic; predictors; recurrence; risk factors; stroke