Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Rustam Al-Shahi Salman, David P. Minks, Dipayan Mitra, Mark A. Rodrigues, Priya Bhatnagar, Johann C. du Plessis, Yogish Joshi, Martin S. Dennis, Gordon D. Murray, David E. Newby, Peter A.G. Sandercock, Nikola Sprigg, Jacqueline Stephen, Cathie L.M. Sudlow, David J. Werring, William N. Whiteley, Joanna M. Wardlaw, Philip M. White, Colin Baigent, Daniel LassersonFrank Sullivan, Johanna Carrie, Javier Rojas, Shannon Amoils, John Bamford, Jane Armitage, Gabriel Rinkel, Gordon Lowe, Jonathan Emberson, Karen Innes, Lynn Dinsmore, Jonathan Drever, Carol Williams, David Perry, Connor McGill, David Buchanan, Allan Walker, Aidan Hutchison, Christopher Matthews, Ruth Fraser, Aileen McGrath, Ann Deary, Rosemary Anderson, Pauli Walker, Christian Hansen, Richard Parker, Aryelly Rodriguez, Malcolm Macleod, Thomas Gattringer, Jeb Palmer, Eleni Sakka, Jennifer Adil-Smith, David Minks, Johannes du Plessis, Christine Lerpiniere, Richard O'Brien, Seona Burgess, Gillian Mead, Ruth Paulton, Fergus Doubal, Katrina McCormick, Neil Hunter, Pat Taylor, Ruwan Parakramawansha, Jack Perry, Gordon Blair, Allan MacRaild, Adrian Parry-Jones, Mary Johnes, Stephanie Lee, Kelly Marie Shaw, Ilse Burger, Martin Punter, Andrea Ingham, Jane Perez, Zin Naing, Jordi Morell, Tracy Marsden, Andrea Hall, Sally Marshall, Louise Harrison, Rowilson Jarapa, Edith Wood, Victoria O'Loughlin, David Cohen, Silvie Davies, Kelechi Njoku, Mushiya Mpelembue, Laura Burgess, Radim Licenik, Mmua Ngwako, Nabeela Nisar, Rangah Niranchanan, Tatjana Roganova, Rajaram Bathula, Joseph Devine, Anette David, Anne Oshodi, Fenglin Guo, Emmanuelle Owoyele, Varthi Sukdeo, Robert Ballantine, Mudhar Abbdul-saheb, Angela Chamberlain, Aberami Chandrakumar, Philip Poku, Kirsty Harkness, Catrin Blank, Emma Richards, Ali Ali, Faith Kibutu, Olesia Balitska, Kathryn Birchall, Pauline Bayliss, Clare Doyle, Kathy Stocks, Arshad Majis, Jo Howe, Christine Kamara, Luke Barron, Ahmad Maatouk, Ralf Lindert, Katy Dakin, Jessica Redgrave, Biju Bhaskaran, Isam Salih, Debs Kelly, Susan Szabo, Dawn Tomlin, Helen Bearne, Jean Buxton, Pauline Fitzell, Georgina Ayres, Afaq Saulat, Kathleen Horan, Joanne Garfield-Smith, Harbens Bhakri, Paul Guyler, Devesh Sinha, Thayalini Loganathan, Amber Siddiqui, Anwer Siddiqui, Lucy Coward, Swapna Kunhunny, Sharon Tysoe, Rajalakshmi Orath Prabakaran, Shyam Kelavkar, Sindhu Rashmi, David Ngo, Kheng Xiong Ng, Nisha Menon, Sweni Shah, Mark Barber, Derek Esson, Fiona Brodie, Talat Anjum, Mushtaq Wani, Manju Krishnan, Leanne Quinn, Jayne Spencer, Terry Jones, Helen Thompson-Jones, Lynne Dacey, Srikanth Chenna, Sharon Storton, Sarah Thomas, Teresa Beaty, Shelley Treadwell, Caroline Davies, Susan Tucker, Lynda Connor, Peter Slade, Glyn Gainard, Girish Muddegowda, Ranjan Sanyal, Alda Remegoso, Nenette Abano, Chelsea Causley, Racquel Carpio, Stephanie Stevens, Adrian Butler, Resti Varquez, Hayley Denic, Francis Alipio, Andrew Moores, Adrian Barry, Holly Maguire, Jeanette Grocott, Kay Finney, Sue Lyjko, Christine Roffe, Joanne Hiden, Phillip Ferdinand, Vera Cvoro, Khalil Ullah, Nicola Chapman, Mandy Couser, Susan Pound, Sean Mcauley, Senthil Raghunathan, Faye Shelton, Amanda Hedstrom, Margi Godfrey, Diane Havard, Amanda Buck, Kailash Krishnan, Nicola Gilzeane, Jack Roffe, Judith Clarke, Katherine Whittamore, Saima Sheikh, Rekha Keshvara, Carla Jordan, Benjamin Jackson, Gwendoline Wilkes, Jason Appleton, Zhe Law, Oliver Matias, Evangelos Vasileiadis, Cathy Mason, Anthea Parry, Geraldine Landers, Melinda Holden, Basaam Aweid, Khalid Rashed, Linda Balian, Carinna Vickers, Elizabeth Keeling, Sarah Board, Joanna Allison, Clare Buckley, Barbara Williams-Yesson, Joanne Board, Tressy Pitt-Kerby, Alfonso Tanate, Diane Wood, Manohar Kini, Dinesh Chadha, Deborah Walstow, Rosanna Fong, Robert Luder, Tolu Adesina, Jill Gallagher, Hayley Bridger, Elodie Murali, Maneesh Bhargava, Chloe van Someren, Frances Harrington, Abhijit Mate, Ali James, Gillian Courtauld, Christine Schofield, Katja Adie, Linda Lucas, Kirsty Bond, Bev Maund, Sam Ellis, Paul Mudd, Martin James, Samantha Keenan, Angela Bowring, Julie Cageao, Hayley Kingwell, Caroline Roughan, Anthony Hemsley, Jane Sword, David Strain, Keniesha Miller, Anita Goff, Karin Gupwell, Kevin Thorpe, Hedley Emsley, Shuja Punekar, Alison McLoughlin, Sulaiman Sultan, Bindu Gregory, Sonia Raj, Donna Doyle, Keith Muir, Wilma Smith, Angela Welch, Fiona Moreton, Bharath Kumar Cheripelli, Salwa El Tawil, Dheeraj Kalladka, Xuya Huang, Nicola Day, Sankaranarayanan Ramachandran, Caroline Crosbie, Jennifer Elliot, Tony Rudd, Katherine Marks, Ajay Bhalla, Jonathan Birns, Sagal Kullane, Nic Weir, Christopher Allen, Vanessa Pressly, Pam Crawford, Emma Battersby-Wood, Alex Blades, Shuna Egerton, Ashleigh Walters, Sue Evans, James Richard Marigold, Fiona Smith, Gabriella Howard, Imogen Gartrell, Simon Smith, Robyn Creeden, Chloe Cox, Cherish Boxall, Jonathan Hewitt, Claire Nott, Procter Sarah, Jessica Whiteman, Steve Buckle, Rebecca Wallace, Rina Mardania, Jane Gray, Claire Triscott, Anand Nair, Jill Greig, Pratap Rana, Matthew Robinson, Mohammad Irfan Alam, David Werring, Duncan Wilson, Caroline Watchurst, Maria Brezitski, Luci Crook, Ifan Jones, Azra Banaras, Krishna Patel, Renuka Erande, Caroline Hogan, Isabel Hostettler, Amy Ashton, Shez Feerick, Nina Francia, Nnebuife Oji, Emma Elliott, Talal Al-Mayhani, Martin Dennis, Cathie Sudlow, William Whiteley, Dipankar Dutta, Pauline Brown, Deborah Ward, Fiona Davis, Jennifer Turfrey, Chloe Hughes, Kayleigh Collins, Rehana Bakawala, Susan O'Connell, Jon Glass, David Broughton, Dinesh Tryambake, Lynn Dixon, Kath Chapman, Andrew Young, Adrian Bergin, Andrew Sigsworth, Aravind Manoj, Glyn Fletcher, Paula Lopez, Penelope Cox, Mark Wilkinson, Paul Fitzsimmons, Nikhil Sharma, James Choulerton, Denise Button, Lindsey Dow, Lukuman Gbadamoshi, Joanne Avis, Barbara Madigan, Stephanie McCann, Louise Shaw, Deborah Howcroft, Suzanne Lucas, Andrew Stone, Gillian Cluckie, Caroline Lovelock, Brian Clarke, Neha Chopra, Natasha Clarke, Bhavini Patel, Kate Kennedy, Rebecca Williams, Adrian Blight, Joanna O'Reilly, Chukwuka Orefo, Nilofer Dayal, Rita Ghatala, Temi Adedoyin, Fran Watson, Sarah Trippier, Lillian Choy, Barry Moynihan, Usman Khan, Val Jones, Naomi Jeyaraj, Lourda Kerin, Kamy Thavanesan, Divya Tiwari, Chantel Cox, Anja Ljubez, Laura Tucker, Arshi Iqbal, Caroline Bagnall, Marketa Keltos, Josh Roberts, Becky Jupp, Catherine Ovington, Emily Rogers, Owen David, Jo Bell, Barbara Longland, Gail Hann, Martin Cooper, Mohammad Nasar, Anoja Rajapakse, Inez Wynter, Ijaz Anwar, Helen Skinner, Tarn Nozedar, Damian McArdle, Balakrishna Kumar, Susan Crawford, Arunkumar Annamalai, Alex Ramshaw, Clare Holmes, Sarah Caine, Mairead Osborn, Emily Dodd, Peter Murphy, Nicola Devitt, Pauline Baker, Amy Steele, Lucy Belle Guthrie, Samantha Clarke, Ahamad Hassan, Dean Waugh, Emelda Veraque, Linetty Makawa, Mary Kambafwile, Marc Randall, Vasileios Papavasileiou, Claire Cullen, Jenny Peters, Hlaing Thant, Tanya Ingram, Mellor Zoe, Ramesh Durairaj, Melanie Harrison, Sarah Stevenson, Daniela Shackcloth, Jordan Ewing, Victoria Sutton, Mark McCarron, Jacqueline McKee, Mandy Doherty, Ferghal McVerry, Caroline Blair, Mary MacLeod, Janice Irvine, Heather Gow, Jacqueline Furnace, Anu Joyson, Baljit Jagpal, Sarah Ross, Katrina Klaasen, Sandra Nelson, Rebecca Clarke, Nichola Crouch, Beverly MacLennan, Vicky Taylor, Daniel Epstein, Avani Shukla, Vinodh Krishnamurthy, Paul Nicholas, Sammie Qureshi, Adam Webber, Justin Penge, Hawraman Ramadan, Stuart Maguire, Chris Patterson, Ruth Bellfield, Brigid Hairsine, Kelvin Stewart, Michaela Hooley, Outi Quinn, Bella Richard, Sally Moseley, Mandy Edwards, Heidi Lawson, Michelle Tayler, Yogish Pai, Mahesh Dhakal, Bernard Esisi, Sofia Dima, Gemma Marie Smith, Mark Garside, Muhammad Naeem, Vidya Baliga, Gill Rogers, Ellen Brown, David Bruce, Rachel Hayman, Susan Clayton, Ed Gamble, Rebecca Grue, Bethan Charles, Adam Hague, Sujata Blane, Caroline Lambert, Afnan Chaudhry, Thomas Harrison, Kari Saastamoinen, Dionne Hove, Laura Howaniec, Gemma Grimwood, Ozlem Redjep, Fiona Humphries, Lucia Argandona, Larissa Cuenoud, Esther Erumere, Sageet Amlani, Grace Auld, Afraim Salek-Haddadi, Ursula Schulz, James Kennedy, Gary Ford, Philip Mathieson, Ian Reckless, Rachel Teal, Giulia 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Malik Hussain, Sarah Brown, Miriam Harvey, Jane Homan, Mohammad Khan, Robert Whiting, Leanne Foote, Nicholas Hunt, Helen Durman, Lucy Brotherton, Jayne Foot, Corinne Pawley, Eliza Foster, Alison Whitcher, Kneale Metcalf, Jenny Jagger, Susan McDonald, Kelly Waterfield, Patrick Sutton, Naval Shinh, Ajmal Anversha, Garth Ravenhill, Richard Greenwood, Janak Saada, Alison Wiltshire, Rebekah Perfitt, Sreeman Andole, Naveen Gadapa, Karen Dunne, Magdalini Krommyda, Evelyne Burssens, Sam King, Catherine Plewa, Nigel Smyth, Jenny Wilson, Elio Giallombardo, Lucy Sykes, Pradeep Kumar, James Barker, Isabel Huggett, Linda Dunn, Charlotte Culmsee, Philip Thomas, Min Myint, Helen Brew, Nikhil Majmudar, Janice OConnell, George Bunea, Charlotte Fox, Diane Gulliver, Andrew Smith, Betty Mokoena, Naweed Sattar, Ramesh Krishnamurthy, Emily Osborne, David Wilson, Belinda Wroath, Kevin Dynan, Michael Power, Susan Thompson, Victoria Adell, Enoch Orugun, Una Poultney, Rachel Glover, Hannah Crowther, Sarah 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Rachael Jones, James Cunningham, Carole Green, Michelle Bates, Raj Shekhar, Ellie Gilham, Iman Ahmed, Rachel Crown, Tracy Fuller, Neetish Goorah, Angela Bell, Christine Kelly, Arun Singh, Jamie Walford, Benjamin Tomlinson, Farzana Patel, Stephen Duberley, Ingrid Kane, Chakravarthi Rajkumar, Jane Gaylard, Joanna Breeds, Nicola Gainsborough, Alexandra Pitt-Ford, Emma Barbon, Laura Latter, Philip Thompson, Simon Hervey, Shrivakumar Krishnamoorthy, Joseph Vassallo, Deborah Walter, Helen Cochrane, Meena Srinivasan, Robert Campbell, Denise Donaldson, Nichola Motherwell, Frances Hurford, Indranil Mukherjee, Antony Kenton, Sheila Nyabadza, Irene Martin, Benjamin Hunt, Hardi Hassan, Sarah O'Toole, Bander Dallol, Janet Putterill, Ratneshwari Jha, Rachel Gallifent, Puneet Kakar, Aparna Pusalkar, kelly Chan, Puneet Dangri, Hannah Beadle, Angela Cook, Karen Crabtree, Santhosh Subramonian, Peter Owusu-Agyei, Natalie Temple, Nicola Butterworth-Cowin, Suzanne Ragab, Kerstin Knops, Emma Jinks, Christine Dickson, Laura Gleave, Judith Dube, Jacqui Leggett, Tatiana Garcia, Sissy Ispoglou, Rachel Evans, Sandeep Ankolekar, Anne Hayes, Hlaing Ni, Bithi Rahman, Josette Milligan, Carol Graham, Josin Jose, Breffni Keegan, Jim Kelly, Richard Dewar, James White, Kelly Thomas

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627. Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05). Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision. Funding: British Heart Foundation.

Original languageEnglish
Pages (from-to)643-652
Number of pages10
JournalThe Lancet Neurology
Volume18
Issue number7
DOIs
Publication statusPublished - Jul 2019

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Cerebral Small Vessel Diseases
Cerebral Hemorrhage
Neuroimaging
Stroke
Therapeutics
Group Psychotherapy
Brain
Random Allocation
Consultants

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases : subgroup analyses of the RESTART randomised, open-label trial. / Al-Shahi Salman, Rustam; Minks, David P.; Mitra, Dipayan; Rodrigues, Mark A.; Bhatnagar, Priya; du Plessis, Johann C.; Joshi, Yogish; Dennis, Martin S.; Murray, Gordon D.; Newby, David E.; Sandercock, Peter A.G.; Sprigg, Nikola; Stephen, Jacqueline; Sudlow, Cathie L.M.; Werring, David J.; Whiteley, William N.; Wardlaw, Joanna M.; White, Philip M.; Baigent, Colin; Lasserson, Daniel; Sullivan, Frank; Carrie, Johanna; Rojas, Javier; Amoils, Shannon; Bamford, John; Armitage, Jane; Rinkel, Gabriel; Lowe, Gordon; Emberson, Jonathan; Innes, Karen; Dinsmore, Lynn; Drever, Jonathan; Williams, Carol; Perry, David; McGill, Connor; Buchanan, David; Walker, Allan; Hutchison, Aidan; Matthews, Christopher; Fraser, Ruth; McGrath, Aileen; Deary, Ann; Anderson, Rosemary; Walker, Pauli; Hansen, Christian; Parker, Richard; Rodriguez, Aryelly; Macleod, Malcolm; Gattringer, Thomas; Palmer, Jeb; Sakka, Eleni; Adil-Smith, Jennifer; Minks, David; du Plessis, Johannes; Lerpiniere, Christine; O'Brien, Richard; Burgess, Seona; Mead, Gillian; Paulton, Ruth; Doubal, Fergus; McCormick, Katrina; Hunter, Neil; Taylor, Pat; Parakramawansha, Ruwan; Perry, Jack; Blair, Gordon; MacRaild, Allan; Parry-Jones, Adrian; Johnes, Mary; Lee, Stephanie; Shaw, Kelly Marie; Burger, Ilse; Punter, Martin; Ingham, Andrea; Perez, Jane; Naing, Zin; Morell, Jordi; Marsden, Tracy; Hall, Andrea; Marshall, Sally; Harrison, Louise; Jarapa, Rowilson; Wood, Edith; O'Loughlin, Victoria; Cohen, David; Davies, Silvie; Njoku, Kelechi; Mpelembue, Mushiya; Burgess, Laura; Licenik, Radim; Ngwako, Mmua; Nisar, Nabeela; Niranchanan, Rangah; Roganova, Tatjana; Bathula, Rajaram; Devine, Joseph; David, Anette; Oshodi, Anne; Guo, Fenglin; Owoyele, Emmanuelle; Sukdeo, Varthi; Ballantine, Robert; Abbdul-saheb, Mudhar; Chamberlain, Angela; Chandrakumar, Aberami; Poku, Philip; Harkness, Kirsty; Blank, Catrin; Richards, Emma; Ali, Ali; Kibutu, Faith; Balitska, Olesia; Birchall, Kathryn; Bayliss, Pauline; Doyle, Clare; Stocks, Kathy; Majis, Arshad; Howe, Jo; Kamara, Christine; Barron, Luke; Maatouk, Ahmad; Lindert, Ralf; Dakin, Katy; Redgrave, Jessica; Bhaskaran, Biju; Salih, Isam; Kelly, Debs; Szabo, Susan; Tomlin, Dawn; Bearne, Helen; Buxton, Jean; Fitzell, Pauline; Ayres, Georgina; Saulat, Afaq; Horan, Kathleen; Garfield-Smith, Joanne; Bhakri, Harbens; Guyler, Paul; Sinha, Devesh; Loganathan, Thayalini; Siddiqui, Amber; Siddiqui, Anwer; Coward, Lucy; Kunhunny, Swapna; Tysoe, Sharon; Orath Prabakaran, Rajalakshmi; Kelavkar, Shyam; Rashmi, Sindhu; Ngo, David; Ng, Kheng Xiong; Menon, Nisha; Shah, Sweni; Barber, Mark; Esson, Derek; Brodie, Fiona; Anjum, Talat; Wani, Mushtaq; Krishnan, Manju; Quinn, Leanne; Spencer, Jayne; Jones, Terry; Thompson-Jones, Helen; Dacey, Lynne; Chenna, Srikanth; Storton, Sharon; Thomas, Sarah; Beaty, Teresa; Treadwell, Shelley; Davies, Caroline; Tucker, Susan; Connor, Lynda; Slade, Peter; Gainard, Glyn; Muddegowda, Girish; Sanyal, Ranjan; Remegoso, Alda; Abano, Nenette; Causley, Chelsea; Carpio, Racquel; Stevens, Stephanie; Butler, Adrian; Varquez, Resti; Denic, Hayley; Alipio, Francis; Moores, Andrew; Barry, Adrian; Maguire, Holly; Grocott, Jeanette; Finney, Kay; Lyjko, Sue; Roffe, Christine; Hiden, Joanne; Ferdinand, Phillip; Cvoro, Vera; Ullah, Khalil; Chapman, Nicola; Couser, Mandy; Pound, Susan; Mcauley, Sean; Raghunathan, Senthil; Shelton, Faye; Hedstrom, Amanda; Godfrey, Margi; Havard, Diane; Buck, Amanda; Krishnan, Kailash; Gilzeane, Nicola; Roffe, Jack; Clarke, Judith; Whittamore, Katherine; Sheikh, Saima; Keshvara, Rekha; Jordan, Carla; Jackson, Benjamin; Wilkes, Gwendoline; Appleton, Jason; Law, Zhe; Matias, Oliver; Vasileiadis, Evangelos; Mason, Cathy; Parry, Anthea; Landers, Geraldine; Holden, Melinda; Aweid, Basaam; Rashed, Khalid; Balian, Linda; Vickers, Carinna; Keeling, Elizabeth; Board, Sarah; Allison, Joanna; Buckley, Clare; Williams-Yesson, Barbara; Board, Joanne; Pitt-Kerby, Tressy; Tanate, Alfonso; Wood, Diane; Kini, Manohar; Chadha, Dinesh; Walstow, Deborah; Fong, Rosanna; Luder, Robert; Adesina, Tolu; Gallagher, Jill; Bridger, Hayley; Murali, Elodie; Bhargava, Maneesh; van Someren, Chloe; Harrington, Frances; Mate, Abhijit; James, Ali; Courtauld, Gillian; Schofield, Christine; Adie, Katja; Lucas, Linda; Bond, Kirsty; Maund, Bev; Ellis, Sam; Mudd, Paul; James, Martin; Keenan, Samantha; Bowring, Angela; Cageao, Julie; Kingwell, Hayley; Roughan, Caroline; Hemsley, Anthony; Sword, Jane; Strain, David; Miller, Keniesha; Goff, Anita; Gupwell, Karin; Thorpe, Kevin; Emsley, Hedley; Punekar, Shuja; McLoughlin, Alison; Sultan, Sulaiman; Gregory, Bindu; Raj, Sonia; Doyle, Donna; Muir, Keith; Smith, Wilma; Welch, Angela; Moreton, Fiona; Cheripelli, Bharath Kumar; El Tawil, Salwa; Kalladka, Dheeraj; Huang, Xuya; Day, Nicola; Ramachandran, Sankaranarayanan; Crosbie, Caroline; Elliot, Jennifer; Rudd, Tony; Marks, Katherine; Bhalla, Ajay; Birns, Jonathan; Kullane, Sagal; Weir, Nic; Allen, Christopher; Pressly, Vanessa; Crawford, Pam; Battersby-Wood, Emma; Blades, Alex; Egerton, Shuna; Walters, Ashleigh; Evans, Sue; Marigold, James Richard; Smith, Fiona; Howard, Gabriella; Gartrell, Imogen; Smith, Simon; Creeden, Robyn; Cox, Chloe; Boxall, Cherish; Hewitt, Jonathan; Nott, Claire; Sarah, Procter; Whiteman, Jessica; Buckle, Steve; Wallace, Rebecca; Mardania, Rina; Gray, Jane; Triscott, Claire; Nair, Anand; Greig, Jill; Rana, Pratap; Robinson, Matthew; Alam, Mohammad Irfan; Werring, David; Wilson, Duncan; Watchurst, Caroline; Brezitski, Maria; Crook, Luci; Jones, Ifan; Banaras, Azra; Patel, Krishna; Erande, Renuka; Hogan, Caroline; Hostettler, Isabel; Ashton, Amy; Feerick, Shez; Francia, Nina; Oji, Nnebuife; Elliott, Emma; Al-Mayhani, Talal; Dennis, Martin; Sudlow, Cathie; Whiteley, William; Dutta, Dipankar; Brown, Pauline; Ward, Deborah; Davis, Fiona; Turfrey, Jennifer; Hughes, Chloe; Collins, Kayleigh; Bakawala, Rehana; O'Connell, Susan; Glass, Jon; Broughton, David; Tryambake, Dinesh; Dixon, Lynn; Chapman, Kath; Young, Andrew; Bergin, Adrian; Sigsworth, Andrew; Manoj, Aravind; Fletcher, Glyn; Lopez, Paula; Cox, Penelope; Wilkinson, Mark; Fitzsimmons, Paul; Sharma, Nikhil; Choulerton, James; Button, Denise; Dow, Lindsey; Gbadamoshi, Lukuman; Avis, Joanne; Madigan, Barbara; McCann, Stephanie; Shaw, Louise; Howcroft, Deborah; Lucas, Suzanne; Stone, Andrew; Cluckie, Gillian; Lovelock, Caroline; Clarke, Brian; Chopra, Neha; Clarke, Natasha; Patel, Bhavini; Kennedy, Kate; Williams, Rebecca; Blight, Adrian; O'Reilly, Joanna; Orefo, Chukwuka; Dayal, Nilofer; Ghatala, Rita; Adedoyin, Temi; Watson, Fran; Trippier, Sarah; Choy, Lillian; Moynihan, Barry; Khan, Usman; Jones, Val; Jeyaraj, Naomi; Kerin, Lourda; Thavanesan, Kamy; Tiwari, Divya; Cox, Chantel; Ljubez, Anja; Tucker, Laura; Iqbal, Arshi; Bagnall, Caroline; Keltos, Marketa; Roberts, Josh; Jupp, Becky; Ovington, Catherine; Rogers, Emily; David, Owen; Bell, Jo; Longland, Barbara; Hann, Gail; Cooper, Martin; Nasar, Mohammad; Rajapakse, Anoja; Wynter, Inez; Anwar, Ijaz; Skinner, Helen; Nozedar, Tarn; McArdle, Damian; Kumar, Balakrishna; Crawford, Susan; Annamalai, Arunkumar; Ramshaw, Alex; Holmes, Clare; Caine, Sarah; Osborn, Mairead; Dodd, Emily; Murphy, Peter; Devitt, Nicola; Baker, Pauline; Steele, Amy; Guthrie, Lucy Belle; Clarke, Samantha; Hassan, Ahamad; Waugh, Dean; Veraque, Emelda; Makawa, Linetty; Kambafwile, Mary; Randall, Marc; Papavasileiou, Vasileios; Cullen, Claire; Peters, Jenny; Thant, Hlaing; Ingram, Tanya; Zoe, Mellor; Durairaj, Ramesh; Harrison, Melanie; Stevenson, Sarah; Shackcloth, Daniela; Ewing, Jordan; Sutton, Victoria; McCarron, Mark; McKee, Jacqueline; Doherty, Mandy; McVerry, Ferghal; Blair, Caroline; MacLeod, Mary; Irvine, Janice; Gow, Heather; Furnace, Jacqueline; Joyson, Anu; Jagpal, Baljit; Ross, Sarah; Klaasen, Katrina; Nelson, Sandra; Clarke, Rebecca; Crouch, Nichola; MacLennan, Beverly; Taylor, Vicky; Epstein, Daniel; Shukla, Avani; Krishnamurthy, Vinodh; Nicholas, Paul; Qureshi, Sammie; Webber, Adam; Penge, Justin; Ramadan, Hawraman; Maguire, Stuart; Patterson, Chris; Bellfield, Ruth; Hairsine, Brigid; Stewart, Kelvin; Hooley, Michaela; Quinn, Outi; Richard, Bella; Moseley, Sally; Edwards, Mandy; Lawson, Heidi; Tayler, Michelle; Pai, Yogish; Dhakal, Mahesh; Esisi, Bernard; Dima, Sofia; Smith, Gemma Marie; Garside, Mark; Naeem, Muhammad; Baliga, Vidya; Rogers, Gill; Brown, Ellen; Bruce, David; Hayman, Rachel; Clayton, Susan; Gamble, Ed; Grue, Rebecca; Charles, Bethan; Hague, Adam; Blane, Sujata; Lambert, Caroline; Chaudhry, Afnan; Harrison, Thomas; Saastamoinen, Kari; Hove, Dionne; Howaniec, Laura; Grimwood, Gemma; Redjep, Ozlem; Humphries, Fiona; Argandona, Lucia; Cuenoud, Larissa; Erumere, Esther; Amlani, Sageet; Auld, Grace; Salek-Haddadi, Afraim; Schulz, Ursula; Kennedy, James; Ford, Gary; Mathieson, Philip; Reckless, Ian; Teal, Rachel; Lenti, Giulia; Harston, George; O'Brien, Eoin; Mcgee, Joanne; Mitchell, Jennifer; Amis, Elaine; Handley, Dominic; Kelly, Siobhan; Zachariah, George; Francis, Jobbin; Crisp, Sarah; Sesay, Juliana; Finlay, Sarah; Hayhoe, Helen; Hannon, Niamh; Hughes, Tom; Morse, Bethan; De Berker, Henry; Tallantyre, Emma; Osman, Ahmed; White, Susan; Schwarz, Stefan; Jelley, Benjamin; Yadava, Rajendra; Azhar, Khalid; Reddan, Julie; Sangombe, Mirriam; Stafford, Samantha; Fotherby, Ken; Morgan, Debbie; Baig, Farrukh; Jennings-Preece, Karla; Butler, Donna; Ahmad, Nasar; Willberry, Angela; Stevens, Angela; Rai, Baljinder; Siddegowda, Prasad; Howard, Peter; Hyatt, Lisa; Dobson, Tracey; Jarrett, David; Ponnambath, Suheil; Tandy, Jane; Harrington-Davies, Yasmin; Butler, Rebecca; James, Claire; Valentine, Stacey; Suttling, Anne; Langhorne, Peter; Kerr, Gillian; Wright, Fiona; Graham, Ruth; McAlpine, Christine; Iqbal, Mohammad Shahzad; Humphreys, Louise; Pasco, Kath; Balazikova, Olga; Nasim, Ashraf; Peixoto, Cassilda; Gallagher, Louise; Shahmehri, Shahrzad; Ghosh, Sandip; Barrie, Elizabeth; Gilmour, Danielle; Henry, Margo; Webb, Tom; Cowie, Linda; Rudenko, Hannah; McDonald, Shanni; Schumacher, Natasha; Walker, Susannah; Cosier, Tracey; Verrion, Anna; Beranova, Eva; Thomson, Audrey; Venter, Marius; Kar, Arindam; Mashate, Sheila; Harvey, Kirsten; Gardener, Léjeune; Nguyen, Vinh; Halse, Omid; Geraghty, Olivia; Hazel, Beth; Wilding, Peter; Tilley, Victoria; Cassidy, Tim; McClelland, Beverley; Bokhari, Maria; England, Timothy; Maddula, Mohana; Donnelly, Richard; Findlay, Paul; Macaden, Ashish; Shread, Ian; Barr, Charlotte; Mohd Nor, Azlisham; Brown, Claire; Persad, Nicola; Eglinton, Charlotte; Weinling, Marie; Hyams, Benjamin; Shah, Alex; Baker, John; Byrne, Anthony; McGhee, Caroline; Smart, Amanda; Copeland, Claire; Carpenter, Michael; Walker, Marion; Davey, Richard; Needle, Ann; Fathima, Razik; Bateman, Gavin; Datta, Prabal; Stanners, Andrew; Jackson, Linda; Ball, Julie; Davis, Michelle; Atkinson, Natalie; Fawcett, Michelle; Thompson, Teresa; Guy, Helen; Hogg, Valerie; Hays, Carole; Woodward, Stephen; Haque, Mohammad; Hakim, Eluzai; Symonds, Stuart; Maanoosi, Mehran; Herman, Jane; Black, Toby; Miriam, Skelton; Clarke, Caroline; Anthony, Alpha; Tribbeck, Michele; Cronin, Julie; Mead, Denise; Fennelly, Ruth; McIlmoyle, James; Dickinson, Christina; Jeffs, Carol; Anwar, Sajjad; Howard, Joanne; Jones, Kirsty; Dhar, Saikat; Clay, Caroline; Siddiq, Muhammad; Ivatts, Simone; Baird, Yolanda; Sally, Moore; Amey, Isobel; Newton, Sophie; Clayton-Evans, Lisa; Chadbourn, Indra; Rayessa, Rayessa; Naylor, Charde; Rodgers, Alicia; Wilson, Lisa; Wilson, Sarah; Clarkson, Emma; Davies, Ruth; Owings, Paula; Sangster, Graeme; Gott, Valerie; Little, Victoria; Weir, Pauline; Cherian, Suja; Jose, Deepa; Moroney, Helen; Downham, Susan; Dodd, Angela; Vettimootal Johnson, Venetia; Codd, Laura; Robinson, Naomi; Ahmed, Ashraf; Albazzaz, Mo; Johnson, Sharon; Denniss, Carol; Cunningham, Mishell; Zahoor, Tajammal; Webster, Timothy; Leason, Sandra; Haider, Syed; Chatterjee, Kausic; Nallasivan, Arumugam; Perkins, Charlotte; Seagrave, Samantha; Jenkins, Colin; Price, Fiona; Hughes, Claire; Mercer, Lily; Hussain, Malik; Brown, Sarah; Harvey, Miriam; Homan, Jane; Khan, Mohammad; Whiting, Robert; Foote, Leanne; Hunt, Nicholas; Durman, Helen; Brotherton, Lucy; Foot, Jayne; Pawley, Corinne; Foster, Eliza; Whitcher, Alison; Metcalf, Kneale; Jagger, Jenny; McDonald, Susan; Waterfield, Kelly; Sutton, Patrick; Shinh, Naval; Anversha, Ajmal; Ravenhill, Garth; Greenwood, Richard; Saada, Janak; Wiltshire, Alison; Perfitt, Rebekah; Andole, Sreeman; Gadapa, Naveen; Dunne, Karen; Krommyda, Magdalini; Burssens, Evelyne; King, Sam; Plewa, Catherine; Smyth, Nigel; Wilson, Jenny; Giallombardo, Elio; Sykes, Lucy; Kumar, Pradeep; Barker, James; Huggett, Isabel; Dunn, Linda; Culmsee, Charlotte; Thomas, Philip; Myint, Min; Brew, Helen; Majmudar, Nikhil; OConnell, Janice; Bunea, George; Fox, Charlotte; Gulliver, Diane; Smith, Andrew; Mokoena, Betty; Sattar, Naweed; Krishnamurthy, Ramesh; Osborne, Emily; Wilson, David; Wroath, Belinda; Dynan, Kevin; Power, Michael; Thompson, Susan; Adell, Victoria; Orugun, Enoch; Poultney, Una; Glover, Rachel; Crowther, Hannah; Thornthwaite, Sarah; Wiggam, Ivan; Wallace, Aine; Kerr, Enda; Fulton, Ailsa; Hunter, Annemarie; Tauro, Suzanne; Cuddy, Sarah; Mangion, David; Hardwick, Anne; Markova, Skarlet; Lawrence, Tara; Constantin, Carmen; Fletcher, Jo; Thomas, Isobel; Pettitt, Kerry; Sekaran, Lakshmanan; Tate, Margaret; Bharaj, Kiranjit; Simon, Rohan; Justin, Frances; Sethuraman, Sakthivel; Phiri, Duke; Mohammed, Niaz; Chauhan, Meena; Elfandi, Khaled; Khan, Uzma; Eveson, David; Mistri, Amit; Manning, Lisa; Khan, Shagufta; Patel, Champa; Moqsith, Mohammed; Sattar, Saira; Lam, Man Yee; Musarrat, Kashif; Stephens, Claire; Kalathil, Latheef; Miller, Richard; Salehin, Maqsud; Gautam, Nikki; Bailey, Duncan; Amor, Kelly; Meir, Julie; Nicolson, Anne; Imam, Javed; Wood, Lisa; White, Julie; Sajid, Mahmud; Ghaly, George; Ball, Margaret; Gascoyne, Rachel; Proeschel, Harald; Sharpe, Simon; Horton, Sarah; Beaves, Emily; Jones, Stephanie; Yip, Brigitte; Bell, Murdina; MacLiver, Linda; MacInnes, Brian; Sims, Don; Hurley, Jennifer; Willmot, Mark; Sutton, Claire; Littleton, Edward; Maiden, Susan; Jones, Rachael; Cunningham, James; Green, Carole; Bates, Michelle; Shekhar, Raj; Gilham, Ellie; Ahmed, Iman; Crown, Rachel; Fuller, Tracy; Goorah, Neetish; Bell, Angela; Kelly, Christine; Singh, Arun; Walford, Jamie; Tomlinson, Benjamin; Patel, Farzana; Duberley, Stephen; Kane, Ingrid; Rajkumar, Chakravarthi; Gaylard, Jane; Breeds, Joanna; Gainsborough, Nicola; Pitt-Ford, Alexandra; Barbon, Emma; Latter, Laura; Thompson, Philip; Hervey, Simon; Krishnamoorthy, Shrivakumar; Vassallo, Joseph; Walter, Deborah; Cochrane, Helen; Srinivasan, Meena; Campbell, Robert; Donaldson, Denise; Motherwell, Nichola; Hurford, Frances; Mukherjee, Indranil; Kenton, Antony; Nyabadza, Sheila; Martin, Irene; Hunt, Benjamin; Hassan, Hardi; O'Toole, Sarah; Dallol, Bander; Putterill, Janet; Jha, Ratneshwari; Gallifent, Rachel; Kakar, Puneet; Pusalkar, Aparna; Chan, kelly; Dangri, Puneet; Beadle, Hannah; Cook, Angela; Crabtree, Karen; Subramonian, Santhosh; Owusu-Agyei, Peter; Temple, Natalie; Butterworth-Cowin, Nicola; Ragab, Suzanne; Knops, Kerstin; Jinks, Emma; Dickson, Christine; Gleave, Laura; Dube, Judith; Leggett, Jacqui; Garcia, Tatiana; Ispoglou, Sissy; Evans, Rachel; Ankolekar, Sandeep; Hayes, Anne; Ni, Hlaing; Rahman, Bithi; Milligan, Josette; Graham, Carol; Jose, Josin; Keegan, Breffni; Kelly, Jim; Dewar, Richard; White, James; Thomas, Kelly.

In: The Lancet Neurology, Vol. 18, No. 7, 07.2019, p. 643-652.

Research output: Contribution to journalArticle

Al-Shahi Salman, R, Minks, DP, Mitra, D, Rodrigues, MA, Bhatnagar, P, du Plessis, JC, Joshi, Y, Dennis, MS, Murray, GD, Newby, DE, Sandercock, PAG, Sprigg, N, Stephen, J, Sudlow, CLM, Werring, DJ, Whiteley, WN, Wardlaw, JM, White, PM, Baigent, C, Lasserson, D, Sullivan, F, Carrie, J, Rojas, J, Amoils, S, Bamford, J, Armitage, J, Rinkel, G, Lowe, G, Emberson, J, Innes, K, Dinsmore, L, Drever, J, Williams, C, Perry, D, McGill, C, Buchanan, D, Walker, A, Hutchison, A, Matthews, C, Fraser, R, McGrath, A, Deary, A, Anderson, R, Walker, P, Hansen, C, Parker, R, Rodriguez, A, Macleod, M, Gattringer, T, Palmer, J, Sakka, E, Adil-Smith, J, Minks, D, du Plessis, J, Lerpiniere, C, O'Brien, R, Burgess, S, Mead, G, Paulton, R, Doubal, F, McCormick, K, Hunter, N, Taylor, P, Parakramawansha, R, Perry, J, Blair, G, MacRaild, A, Parry-Jones, A, Johnes, M, Lee, S, Shaw, KM, Burger, I, Punter, M, Ingham, A, Perez, J, Naing, Z, Morell, J, Marsden, T, Hall, A, Marshall, S, Harrison, L, Jarapa, R, Wood, E, 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intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial', The Lancet Neurology, vol. 18, no. 7, pp. 643-652. https://doi.org/10.1016/S1474-4422(19)30184-X
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Ahmed, Iman ; Crown, Rachel ; Fuller, Tracy ; Goorah, Neetish ; Bell, Angela ; Kelly, Christine ; Singh, Arun ; Walford, Jamie ; Tomlinson, Benjamin ; Patel, Farzana ; Duberley, Stephen ; Kane, Ingrid ; Rajkumar, Chakravarthi ; Gaylard, Jane ; Breeds, Joanna ; Gainsborough, Nicola ; Pitt-Ford, Alexandra ; Barbon, Emma ; Latter, Laura ; Thompson, Philip ; Hervey, Simon ; Krishnamoorthy, Shrivakumar ; Vassallo, Joseph ; Walter, Deborah ; Cochrane, Helen ; Srinivasan, Meena ; Campbell, Robert ; Donaldson, Denise ; Motherwell, Nichola ; Hurford, Frances ; Mukherjee, Indranil ; Kenton, Antony ; Nyabadza, Sheila ; Martin, Irene ; Hunt, Benjamin ; Hassan, Hardi ; O'Toole, Sarah ; Dallol, Bander ; Putterill, Janet ; Jha, Ratneshwari ; Gallifent, Rachel ; Kakar, Puneet ; Pusalkar, Aparna ; Chan, kelly ; Dangri, Puneet ; Beadle, Hannah ; Cook, Angela ; Crabtree, Karen ; Subramonian, Santhosh ; Owusu-Agyei, Peter ; Temple, Natalie ; Butterworth-Cowin, Nicola ; Ragab, Suzanne ; Knops, Kerstin ; Jinks, Emma ; Dickson, Christine ; Gleave, Laura ; Dube, Judith ; Leggett, Jacqui ; Garcia, Tatiana ; Ispoglou, Sissy ; Evans, Rachel ; Ankolekar, Sandeep ; Hayes, Anne ; Ni, Hlaing ; Rahman, Bithi ; Milligan, Josette ; Graham, Carol ; Jose, Josin ; Keegan, Breffni ; Kelly, Jim ; Dewar, Richard ; White, James ; Thomas, Kelly. / Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases : subgroup analyses of the RESTART randomised, open-label trial. In: The Lancet Neurology. 2019 ; Vol. 18, No. 7. pp. 643-652.
@article{a6163338a53246078c16ac343d7a3ef4,
title = "Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial",
abstract = "Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627. Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98{\%}) had intracerebral haemorrhage: 507 (97{\%}) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48{\%}) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95{\%} CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05). Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision. Funding: British Heart Foundation.",
author = "{Al-Shahi Salman}, Rustam and Minks, {David P.} and Dipayan Mitra and Rodrigues, {Mark A.} and Priya Bhatnagar and {du Plessis}, {Johann C.} and Yogish Joshi and Dennis, {Martin S.} and Murray, {Gordon D.} and Newby, {David E.} and Sandercock, {Peter A.G.} and Nikola Sprigg and Jacqueline Stephen and Sudlow, {Cathie L.M.} and Werring, {David J.} and Whiteley, {William N.} and Wardlaw, {Joanna M.} and White, {Philip M.} and Colin Baigent and Daniel Lasserson and Frank Sullivan and Johanna Carrie and Javier Rojas and Shannon Amoils and John Bamford and Jane Armitage and Gabriel Rinkel and Gordon Lowe and Jonathan Emberson and Karen Innes and Lynn Dinsmore and Jonathan Drever and Carol Williams and David Perry and Connor McGill and David Buchanan and Allan Walker and Aidan Hutchison and Christopher Matthews and Ruth Fraser and Aileen McGrath and Ann Deary and Rosemary Anderson and Pauli Walker and Christian Hansen and Richard Parker and Aryelly Rodriguez and Malcolm Macleod and Thomas Gattringer and Jeb Palmer and Eleni Sakka and Jennifer Adil-Smith and David Minks and {du Plessis}, Johannes and Christine Lerpiniere and Richard O'Brien and Seona Burgess and Gillian Mead and Ruth Paulton and Fergus Doubal and Katrina McCormick and Neil Hunter and Pat Taylor and Ruwan Parakramawansha and Jack Perry and Gordon Blair and Allan MacRaild and Adrian Parry-Jones and Mary Johnes and Stephanie Lee and Shaw, {Kelly Marie} and Ilse Burger and Martin Punter and Andrea Ingham and Jane Perez and Zin Naing and Jordi Morell and Tracy Marsden and Andrea Hall and Sally Marshall and Louise Harrison and Rowilson Jarapa and Edith Wood and Victoria O'Loughlin and David Cohen and Silvie Davies and Kelechi Njoku and Mushiya Mpelembue and Laura Burgess and Radim Licenik and Mmua Ngwako and Nabeela Nisar and Rangah Niranchanan and Tatjana Roganova and Rajaram Bathula and Joseph Devine and Anette David and Anne Oshodi and Fenglin Guo and Emmanuelle Owoyele and Varthi Sukdeo and Robert Ballantine and Mudhar Abbdul-saheb and Angela Chamberlain and Aberami Chandrakumar and Philip Poku and Kirsty Harkness and Catrin Blank and Emma Richards and Ali Ali and Faith Kibutu and Olesia Balitska and Kathryn Birchall and Pauline Bayliss and Clare Doyle and Kathy Stocks and Arshad Majis and Jo Howe and Christine Kamara and Luke Barron and Ahmad Maatouk and Ralf Lindert and Katy Dakin and Jessica Redgrave and Biju Bhaskaran and Isam Salih and Debs Kelly and Susan Szabo and Dawn Tomlin and Helen Bearne and Jean Buxton and Pauline Fitzell and Georgina Ayres and Afaq Saulat and Kathleen Horan and Joanne Garfield-Smith and Harbens Bhakri and Paul Guyler and Devesh Sinha and Thayalini Loganathan and Amber Siddiqui and Anwer Siddiqui and Lucy Coward and Swapna Kunhunny and Sharon Tysoe and {Orath Prabakaran}, Rajalakshmi and Shyam Kelavkar and Sindhu Rashmi and David Ngo and Ng, {Kheng Xiong} and Nisha Menon and Sweni Shah and Mark Barber and Derek Esson and Fiona Brodie and Talat Anjum and Mushtaq Wani and Manju Krishnan and Leanne Quinn and Jayne Spencer and Terry Jones and Helen Thompson-Jones and Lynne Dacey and Srikanth Chenna and Sharon Storton and Sarah Thomas and Teresa Beaty and Shelley Treadwell and Caroline Davies and Susan Tucker and Lynda Connor and Peter Slade and Glyn Gainard and Girish Muddegowda and Ranjan Sanyal and Alda Remegoso and Nenette Abano and Chelsea Causley and Racquel Carpio and Stephanie Stevens and Adrian Butler and Resti Varquez and Hayley Denic and Francis Alipio and Andrew Moores and Adrian Barry and Holly Maguire and Jeanette Grocott and Kay Finney and Sue Lyjko and Christine Roffe and Joanne Hiden and Phillip Ferdinand and Vera Cvoro and Khalil Ullah and Nicola Chapman and Mandy Couser and Susan Pound and Sean Mcauley and Senthil Raghunathan and Faye Shelton and Amanda Hedstrom and Margi Godfrey and Diane Havard and Amanda Buck and Kailash Krishnan and Nicola Gilzeane and Jack Roffe and Judith Clarke and Katherine Whittamore and Saima Sheikh and Rekha Keshvara and Carla Jordan and Benjamin Jackson and Gwendoline Wilkes and Jason Appleton and Zhe Law and Oliver Matias and Evangelos Vasileiadis and Cathy Mason and Anthea Parry and Geraldine Landers and Melinda Holden and Basaam Aweid and Khalid Rashed and Linda Balian and Carinna Vickers and Elizabeth Keeling and Sarah Board and Joanna Allison and Clare Buckley and Barbara Williams-Yesson and Joanne Board and Tressy Pitt-Kerby and Alfonso Tanate and Diane Wood and Manohar Kini and Dinesh Chadha and Deborah Walstow and Rosanna Fong and Robert Luder and Tolu Adesina and Jill Gallagher and Hayley Bridger and Elodie Murali and Maneesh Bhargava and {van Someren}, Chloe and Frances Harrington and Abhijit Mate and Ali James and Gillian Courtauld and Christine Schofield and Katja Adie and Linda Lucas and Kirsty Bond and Bev Maund and Sam Ellis and Paul Mudd and Martin James and Samantha Keenan and Angela Bowring and Julie Cageao and Hayley Kingwell and Caroline Roughan and Anthony Hemsley and Jane Sword and David Strain and Keniesha Miller and Anita Goff and Karin Gupwell and Kevin Thorpe and Hedley Emsley and Shuja Punekar and Alison McLoughlin and Sulaiman Sultan and Bindu Gregory and Sonia Raj and Donna Doyle and Keith Muir and Wilma Smith and Angela Welch and Fiona Moreton and Cheripelli, {Bharath Kumar} and {El Tawil}, Salwa and Dheeraj Kalladka and Xuya Huang and Nicola Day and Sankaranarayanan Ramachandran and Caroline Crosbie and Jennifer Elliot and Tony Rudd and Katherine Marks and Ajay Bhalla and Jonathan Birns and Sagal Kullane and Nic Weir and Christopher Allen and Vanessa Pressly and Pam Crawford and Emma Battersby-Wood and Alex Blades and Shuna Egerton and Ashleigh Walters and Sue Evans and Marigold, {James Richard} and Fiona Smith and Gabriella Howard and Imogen Gartrell and Simon Smith and Robyn Creeden and Chloe Cox and Cherish Boxall and Jonathan Hewitt and Claire Nott and Procter Sarah and Jessica Whiteman and Steve Buckle and Rebecca Wallace and Rina Mardania and Jane Gray and Claire Triscott and Anand Nair and Jill Greig and Pratap Rana and Matthew Robinson and Alam, {Mohammad Irfan} and David Werring and Duncan Wilson and Caroline Watchurst and Maria Brezitski and Luci Crook and Ifan Jones and Azra Banaras and Krishna Patel and Renuka Erande and Caroline Hogan and Isabel Hostettler and Amy Ashton and Shez Feerick and Nina Francia and Nnebuife Oji and Emma Elliott and Talal Al-Mayhani and Martin Dennis and Cathie Sudlow and William Whiteley and Dipankar Dutta and Pauline Brown and Deborah Ward and Fiona Davis and Jennifer Turfrey and Chloe Hughes and Kayleigh Collins and Rehana Bakawala and Susan O'Connell and Jon Glass and David Broughton and Dinesh Tryambake and Lynn Dixon and Kath Chapman and Andrew Young and Adrian Bergin and Andrew Sigsworth and Aravind Manoj and Glyn Fletcher and Paula Lopez and Penelope Cox and Mark Wilkinson and Paul Fitzsimmons and Nikhil Sharma and James Choulerton and Denise Button and Lindsey Dow and Lukuman Gbadamoshi and Joanne Avis and Barbara Madigan and Stephanie McCann and Louise Shaw and Deborah Howcroft and Suzanne Lucas and Andrew Stone and Gillian Cluckie and Caroline Lovelock and Brian Clarke and Neha Chopra and Natasha Clarke and Bhavini Patel and Kate Kennedy and Rebecca Williams and Adrian Blight and Joanna O'Reilly and Chukwuka Orefo and Nilofer Dayal and Rita Ghatala and Temi Adedoyin and Fran Watson and Sarah Trippier and Lillian Choy and Barry Moynihan and Usman Khan and Val Jones and Naomi Jeyaraj and Lourda Kerin and Kamy Thavanesan and Divya Tiwari and Chantel Cox and Anja Ljubez and Laura Tucker and Arshi Iqbal and Caroline Bagnall and Marketa Keltos and Josh Roberts and Becky Jupp and Catherine Ovington and Emily Rogers and Owen David and Jo Bell and Barbara Longland and Gail Hann and Martin Cooper and Mohammad Nasar and Anoja Rajapakse and Inez Wynter and Ijaz Anwar and Helen Skinner and Tarn Nozedar and Damian McArdle and Balakrishna Kumar and Susan Crawford and Arunkumar Annamalai and Alex Ramshaw and Clare Holmes and Sarah Caine and Mairead Osborn and Emily Dodd and Peter Murphy and Nicola Devitt and Pauline Baker and Amy Steele and Guthrie, {Lucy Belle} and Samantha Clarke and Ahamad Hassan and Dean Waugh and Emelda Veraque and Linetty Makawa and Mary Kambafwile and Marc Randall and Vasileios Papavasileiou and Claire Cullen and Jenny Peters and Hlaing Thant and Tanya Ingram and Mellor Zoe and Ramesh Durairaj and Melanie Harrison and Sarah Stevenson and Daniela Shackcloth and Jordan Ewing and Victoria Sutton and Mark McCarron and Jacqueline McKee and Mandy Doherty and Ferghal McVerry and Caroline Blair and Mary MacLeod and Janice Irvine and Heather Gow and Jacqueline Furnace and Anu Joyson and Baljit Jagpal and Sarah Ross and Katrina Klaasen and Sandra Nelson and Rebecca Clarke and Nichola Crouch and Beverly MacLennan and Vicky Taylor and Daniel Epstein and Avani Shukla and Vinodh Krishnamurthy and Paul Nicholas and Sammie Qureshi and Adam Webber and Justin Penge and Hawraman Ramadan and Stuart Maguire and Chris Patterson and Ruth Bellfield and Brigid Hairsine and Kelvin Stewart and Michaela Hooley and Outi Quinn and Bella Richard and Sally Moseley and Mandy Edwards and Heidi Lawson and Michelle Tayler and Yogish Pai and Mahesh Dhakal and Bernard Esisi and Sofia Dima and Smith, {Gemma Marie} and Mark Garside and Muhammad Naeem and Vidya Baliga and Gill Rogers and Ellen Brown and David Bruce and Rachel Hayman and Susan Clayton and Ed Gamble and Rebecca Grue and Bethan Charles and Adam Hague and Sujata Blane and Caroline Lambert and Afnan Chaudhry and Thomas Harrison and Kari Saastamoinen and Dionne Hove and Laura Howaniec and Gemma Grimwood and Ozlem Redjep and Fiona Humphries and Lucia Argandona and Larissa Cuenoud and Esther Erumere and Sageet Amlani and Grace Auld and Afraim Salek-Haddadi and Ursula Schulz and James Kennedy and Gary Ford and Philip Mathieson and Ian Reckless and Rachel Teal and Giulia Lenti and George Harston and Eoin O'Brien and Joanne Mcgee and Jennifer Mitchell and Elaine Amis and Dominic Handley and Siobhan Kelly and George Zachariah and Jobbin Francis and Sarah Crisp and Juliana Sesay and Sarah Finlay and Helen Hayhoe and Niamh Hannon and Tom Hughes and Bethan Morse and {De Berker}, Henry and Emma Tallantyre and Ahmed Osman and Susan White and Stefan Schwarz and Benjamin Jelley and Rajendra Yadava and Khalid Azhar and Julie Reddan and Mirriam Sangombe and Samantha Stafford and Ken Fotherby and Debbie Morgan and Farrukh Baig and Karla Jennings-Preece and Donna Butler and Nasar Ahmad and Angela Willberry and Angela Stevens and Baljinder Rai and Prasad Siddegowda and Peter Howard and Lisa Hyatt and Tracey Dobson and David Jarrett and Suheil Ponnambath and Jane Tandy and Yasmin Harrington-Davies and Rebecca Butler and Claire James and Stacey Valentine and Anne Suttling and Peter Langhorne and Gillian Kerr and Fiona Wright and Ruth Graham and Christine McAlpine and Iqbal, {Mohammad Shahzad} and Louise Humphreys and Kath Pasco and Olga Balazikova and Ashraf Nasim and Cassilda Peixoto and Louise Gallagher and Shahrzad Shahmehri and Sandip Ghosh and Elizabeth Barrie and Danielle Gilmour and Margo Henry and Tom Webb and Linda Cowie and Hannah Rudenko and Shanni McDonald and Natasha Schumacher and Susannah Walker and Tracey Cosier and Anna Verrion and Eva Beranova and Audrey Thomson and Marius Venter and Arindam Kar and Sheila Mashate and Kirsten Harvey and L{\'e}jeune Gardener and Vinh Nguyen and Omid Halse and Olivia Geraghty and Beth Hazel and Peter Wilding and Victoria Tilley and Tim Cassidy and Beverley McClelland and Maria Bokhari and Timothy England and Mohana Maddula and Richard Donnelly and Paul Findlay and Ashish Macaden and Ian Shread and Charlotte Barr and {Mohd Nor}, Azlisham and Claire Brown and Nicola Persad and Charlotte Eglinton and Marie Weinling and Benjamin Hyams and Alex Shah and John Baker and Anthony Byrne and Caroline McGhee and Amanda Smart and Claire Copeland and Michael Carpenter and Marion Walker and Richard Davey and Ann Needle and Razik Fathima and Gavin Bateman and Prabal Datta and Andrew Stanners and Linda Jackson and Julie Ball and Michelle Davis and Natalie Atkinson and Michelle Fawcett and Teresa Thompson and Helen Guy and Valerie Hogg and Carole Hays and Stephen Woodward and Mohammad Haque and Eluzai Hakim and Stuart Symonds and Mehran Maanoosi and Jane Herman and Toby Black and Skelton Miriam and Caroline Clarke and Alpha Anthony and Michele Tribbeck and Julie Cronin and Denise Mead and Ruth Fennelly and James McIlmoyle and Christina Dickinson and Carol Jeffs and Sajjad Anwar and Joanne Howard and Kirsty Jones and Saikat Dhar and Caroline Clay and Muhammad Siddiq and Simone Ivatts and Yolanda Baird and Moore Sally and Isobel Amey and Sophie Newton and Lisa Clayton-Evans and Indra Chadbourn and Rayessa Rayessa and Charde Naylor and Alicia Rodgers and Lisa Wilson and Sarah Wilson and Emma Clarkson and Ruth Davies and Paula Owings and Graeme Sangster and Valerie Gott and Victoria Little and Pauline Weir and Suja Cherian and Deepa Jose and Helen Moroney and Susan Downham and Angela Dodd and {Vettimootal Johnson}, Venetia and Laura Codd and Naomi Robinson and Ashraf Ahmed and Mo Albazzaz and Sharon Johnson and Carol Denniss and Mishell Cunningham and Tajammal Zahoor and Timothy Webster and Sandra Leason and Syed Haider and Kausic Chatterjee and Arumugam Nallasivan and Charlotte Perkins and Samantha Seagrave and Colin Jenkins and Fiona Price and Claire Hughes and Lily Mercer and Malik Hussain and Sarah Brown and Miriam Harvey and Jane Homan and Mohammad Khan and Robert Whiting and Leanne Foote and Nicholas Hunt and Helen Durman and Lucy Brotherton and Jayne Foot and Corinne Pawley and Eliza Foster and Alison Whitcher and Kneale Metcalf and Jenny Jagger and Susan McDonald and Kelly Waterfield and Patrick Sutton and Naval Shinh and Ajmal Anversha and Garth Ravenhill and Richard Greenwood and Janak Saada and Alison Wiltshire and Rebekah Perfitt and Sreeman Andole and Naveen Gadapa and Karen Dunne and Magdalini Krommyda and Evelyne Burssens and Sam King and Catherine Plewa and Nigel Smyth and Jenny Wilson and Elio Giallombardo and Lucy Sykes and Pradeep Kumar and James Barker and Isabel Huggett and Linda Dunn and Charlotte Culmsee and Philip Thomas and Min Myint and Helen Brew and Nikhil Majmudar and Janice OConnell and George Bunea and Charlotte Fox and Diane Gulliver and Andrew Smith and Betty Mokoena and Naweed Sattar and Ramesh Krishnamurthy and Emily Osborne and David Wilson and Belinda Wroath and Kevin Dynan and Michael Power and Susan Thompson and Victoria Adell and Enoch Orugun and Una Poultney and Rachel Glover and Hannah Crowther and Sarah Thornthwaite and Ivan Wiggam and Aine Wallace and Enda Kerr and Ailsa Fulton and Annemarie Hunter and Suzanne Tauro and Sarah Cuddy and David Mangion and Anne Hardwick and Skarlet Markova and Tara Lawrence and Carmen Constantin and Jo Fletcher and Isobel Thomas and Kerry Pettitt and Lakshmanan Sekaran and Margaret Tate and Kiranjit Bharaj and Rohan Simon and Frances Justin and Sakthivel Sethuraman and Duke Phiri and Niaz Mohammed and Meena Chauhan and Khaled Elfandi and Uzma Khan and David Eveson and Amit Mistri and Lisa Manning and Shagufta Khan and Champa Patel and Mohammed Moqsith and Saira Sattar and Lam, {Man Yee} and Kashif Musarrat and Claire Stephens and Latheef Kalathil and Richard Miller and Maqsud Salehin and Nikki Gautam and Duncan Bailey and Kelly Amor and Julie Meir and Anne Nicolson and Javed Imam and Lisa Wood and Julie White and Mahmud Sajid and George Ghaly and Margaret Ball and Rachel Gascoyne and Harald Proeschel and Simon Sharpe and Sarah Horton and Emily Beaves and Stephanie Jones and Brigitte Yip and Murdina Bell and Linda MacLiver and Brian MacInnes and Don Sims and Jennifer Hurley and Mark Willmot and Claire Sutton and Edward Littleton and Susan Maiden and Rachael Jones and James Cunningham and Carole Green and Michelle Bates and Raj Shekhar and Ellie Gilham and Iman Ahmed and Rachel Crown and Tracy Fuller and Neetish Goorah and Angela Bell and Christine Kelly and Arun Singh and Jamie Walford and Benjamin Tomlinson and Farzana Patel and Stephen Duberley and Ingrid Kane and Chakravarthi Rajkumar and Jane Gaylard and Joanna Breeds and Nicola Gainsborough and Alexandra Pitt-Ford and Emma Barbon and Laura Latter and Philip Thompson and Simon Hervey and Shrivakumar Krishnamoorthy and Joseph Vassallo and Deborah Walter and Helen Cochrane and Meena Srinivasan and Robert Campbell and Denise Donaldson and Nichola Motherwell and Frances Hurford and Indranil Mukherjee and Antony Kenton and Sheila Nyabadza and Irene Martin and Benjamin Hunt and Hardi Hassan and Sarah O'Toole and Bander Dallol and Janet Putterill and Ratneshwari Jha and Rachel Gallifent and Puneet Kakar and Aparna Pusalkar and kelly Chan and Puneet Dangri and Hannah Beadle and Angela Cook and Karen Crabtree and Santhosh Subramonian and Peter Owusu-Agyei and Natalie Temple and Nicola Butterworth-Cowin and Suzanne Ragab and Kerstin Knops and Emma Jinks and Christine Dickson and Laura Gleave and Judith Dube and Jacqui Leggett and Tatiana Garcia and Sissy Ispoglou and Rachel Evans and Sandeep Ankolekar and Anne Hayes and Hlaing Ni and Bithi Rahman and Josette Milligan and Carol Graham and Josin Jose and Breffni Keegan and Jim Kelly and Richard Dewar and James White and Kelly Thomas",
year = "2019",
month = "7",
doi = "10.1016/S1474-4422(19)30184-X",
language = "English",
volume = "18",
pages = "643--652",
journal = "The Lancet Neurology",
issn = "1474-4422",
publisher = "Lancet Publishing Group",
number = "7",

}

TY - JOUR

T1 - Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases

T2 - subgroup analyses of the RESTART randomised, open-label trial

AU - Al-Shahi Salman, Rustam

AU - Minks, David P.

AU - Mitra, Dipayan

AU - Rodrigues, Mark A.

AU - Bhatnagar, Priya

AU - du Plessis, Johann C.

AU - Joshi, Yogish

AU - Dennis, Martin S.

AU - Murray, Gordon D.

AU - Newby, David E.

AU - Sandercock, Peter A.G.

AU - Sprigg, Nikola

AU - Stephen, Jacqueline

AU - Sudlow, Cathie L.M.

AU - Werring, David J.

AU - Whiteley, William N.

AU - Wardlaw, Joanna M.

AU - White, Philip M.

AU - Baigent, Colin

AU - Lasserson, Daniel

AU - Sullivan, Frank

AU - Carrie, Johanna

AU - Rojas, Javier

AU - Amoils, Shannon

AU - Bamford, John

AU - Armitage, Jane

AU - Rinkel, Gabriel

AU - Lowe, Gordon

AU - Emberson, Jonathan

AU - Innes, Karen

AU - Dinsmore, Lynn

AU - Drever, Jonathan

AU - Williams, Carol

AU - Perry, David

AU - McGill, Connor

AU - Buchanan, David

AU - Walker, Allan

AU - Hutchison, Aidan

AU - Matthews, Christopher

AU - Fraser, Ruth

AU - McGrath, Aileen

AU - Deary, Ann

AU - Anderson, Rosemary

AU - Walker, Pauli

AU - Hansen, Christian

AU - Parker, Richard

AU - Rodriguez, Aryelly

AU - Macleod, Malcolm

AU - Gattringer, Thomas

AU - Palmer, Jeb

AU - Sakka, Eleni

AU - Adil-Smith, Jennifer

AU - Minks, David

AU - du Plessis, Johannes

AU - Lerpiniere, Christine

AU - O'Brien, Richard

AU - Burgess, Seona

AU - Mead, Gillian

AU - Paulton, Ruth

AU - Doubal, Fergus

AU - McCormick, Katrina

AU - Hunter, Neil

AU - Taylor, Pat

AU - Parakramawansha, Ruwan

AU - Perry, Jack

AU - Blair, Gordon

AU - MacRaild, Allan

AU - Parry-Jones, Adrian

AU - Johnes, Mary

AU - Lee, Stephanie

AU - Shaw, Kelly Marie

AU - Burger, Ilse

AU - Punter, Martin

AU - Ingham, Andrea

AU - Perez, Jane

AU - Naing, Zin

AU - Morell, Jordi

AU - Marsden, Tracy

AU - Hall, Andrea

AU - Marshall, Sally

AU - Harrison, Louise

AU - Jarapa, Rowilson

AU - Wood, Edith

AU - O'Loughlin, Victoria

AU - Cohen, David

AU - Davies, Silvie

AU - Njoku, Kelechi

AU - Mpelembue, Mushiya

AU - Burgess, Laura

AU - Licenik, Radim

AU - Ngwako, Mmua

AU - Nisar, Nabeela

AU - Niranchanan, Rangah

AU - Roganova, Tatjana

AU - Bathula, Rajaram

AU - Devine, Joseph

AU - David, Anette

AU - Oshodi, Anne

AU - Guo, Fenglin

AU - Owoyele, Emmanuelle

AU - Sukdeo, Varthi

AU - Ballantine, Robert

AU - Abbdul-saheb, Mudhar

AU - Chamberlain, Angela

AU - Chandrakumar, Aberami

AU - Poku, Philip

AU - Harkness, Kirsty

AU - Blank, Catrin

AU - Richards, Emma

AU - Ali, Ali

AU - Kibutu, Faith

AU - Balitska, Olesia

AU - Birchall, Kathryn

AU - Bayliss, Pauline

AU - Doyle, Clare

AU - Stocks, Kathy

AU - Majis, Arshad

AU - Howe, Jo

AU - Kamara, Christine

AU - Barron, Luke

AU - Maatouk, Ahmad

AU - Lindert, Ralf

AU - Dakin, Katy

AU - Redgrave, Jessica

AU - Bhaskaran, Biju

AU - Salih, Isam

AU - Kelly, Debs

AU - Szabo, Susan

AU - Tomlin, Dawn

AU - Bearne, Helen

AU - Buxton, Jean

AU - Fitzell, Pauline

AU - Ayres, Georgina

AU - Saulat, Afaq

AU - Horan, Kathleen

AU - Garfield-Smith, Joanne

AU - Bhakri, Harbens

AU - Guyler, Paul

AU - Sinha, Devesh

AU - Loganathan, Thayalini

AU - Siddiqui, Amber

AU - Siddiqui, Anwer

AU - Coward, Lucy

AU - Kunhunny, Swapna

AU - Tysoe, Sharon

AU - Orath Prabakaran, Rajalakshmi

AU - Kelavkar, Shyam

AU - Rashmi, Sindhu

AU - Ngo, David

AU - Ng, Kheng Xiong

AU - Menon, Nisha

AU - Shah, Sweni

AU - Barber, Mark

AU - Esson, Derek

AU - Brodie, Fiona

AU - Anjum, Talat

AU - Wani, Mushtaq

AU - Krishnan, Manju

AU - Quinn, Leanne

AU - Spencer, Jayne

AU - Jones, Terry

AU - Thompson-Jones, Helen

AU - Dacey, Lynne

AU - Chenna, Srikanth

AU - Storton, Sharon

AU - Thomas, Sarah

AU - Beaty, Teresa

AU - Treadwell, Shelley

AU - Davies, Caroline

AU - Tucker, Susan

AU - Connor, Lynda

AU - Slade, Peter

AU - Gainard, Glyn

AU - Muddegowda, Girish

AU - Sanyal, Ranjan

AU - Remegoso, Alda

AU - Abano, Nenette

AU - Causley, Chelsea

AU - Carpio, Racquel

AU - Stevens, Stephanie

AU - Butler, Adrian

AU - Varquez, Resti

AU - Denic, Hayley

AU - Alipio, Francis

AU - Moores, Andrew

AU - Barry, Adrian

AU - Maguire, Holly

AU - Grocott, Jeanette

AU - Finney, Kay

AU - Lyjko, Sue

AU - Roffe, Christine

AU - Hiden, Joanne

AU - Ferdinand, Phillip

AU - Cvoro, Vera

AU - Ullah, Khalil

AU - Chapman, Nicola

AU - Couser, Mandy

AU - Pound, Susan

AU - Mcauley, Sean

AU - Raghunathan, Senthil

AU - Shelton, Faye

AU - Hedstrom, Amanda

AU - Godfrey, Margi

AU - Havard, Diane

AU - Buck, Amanda

AU - Krishnan, Kailash

AU - Gilzeane, Nicola

AU - Roffe, Jack

AU - Clarke, Judith

AU - Whittamore, Katherine

AU - Sheikh, Saima

AU - Keshvara, Rekha

AU - Jordan, Carla

AU - Jackson, Benjamin

AU - Wilkes, Gwendoline

AU - Appleton, Jason

AU - Law, Zhe

AU - Matias, Oliver

AU - Vasileiadis, Evangelos

AU - Mason, Cathy

AU - Parry, Anthea

AU - Landers, Geraldine

AU - Holden, Melinda

AU - Aweid, Basaam

AU - Rashed, Khalid

AU - Balian, Linda

AU - Vickers, Carinna

AU - Keeling, Elizabeth

AU - Board, Sarah

AU - Allison, Joanna

AU - Buckley, Clare

AU - Williams-Yesson, Barbara

AU - Board, Joanne

AU - Pitt-Kerby, Tressy

AU - Tanate, Alfonso

AU - Wood, Diane

AU - Kini, Manohar

AU - Chadha, Dinesh

AU - Walstow, Deborah

AU - Fong, Rosanna

AU - Luder, Robert

AU - Adesina, Tolu

AU - Gallagher, Jill

AU - Bridger, Hayley

AU - Murali, Elodie

AU - Bhargava, Maneesh

AU - van Someren, Chloe

AU - Harrington, Frances

AU - Mate, Abhijit

AU - James, Ali

AU - Courtauld, Gillian

AU - Schofield, Christine

AU - Adie, Katja

AU - Lucas, Linda

AU - Bond, Kirsty

AU - Maund, Bev

AU - Ellis, Sam

AU - Mudd, Paul

AU - James, Martin

AU - Keenan, Samantha

AU - Bowring, Angela

AU - Cageao, Julie

AU - Kingwell, Hayley

AU - Roughan, Caroline

AU - Hemsley, Anthony

AU - Sword, Jane

AU - Strain, David

AU - Miller, Keniesha

AU - Goff, Anita

AU - Gupwell, Karin

AU - Thorpe, Kevin

AU - Emsley, Hedley

AU - Punekar, Shuja

AU - McLoughlin, Alison

AU - Sultan, Sulaiman

AU - Gregory, Bindu

AU - Raj, Sonia

AU - Doyle, Donna

AU - Muir, Keith

AU - Smith, Wilma

AU - Welch, Angela

AU - Moreton, Fiona

AU - Cheripelli, Bharath Kumar

AU - El Tawil, Salwa

AU - Kalladka, Dheeraj

AU - Huang, Xuya

AU - Day, Nicola

AU - Ramachandran, Sankaranarayanan

AU - Crosbie, Caroline

AU - Elliot, Jennifer

AU - Rudd, Tony

AU - Marks, Katherine

AU - Bhalla, Ajay

AU - Birns, Jonathan

AU - Kullane, Sagal

AU - Weir, Nic

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AU - Tomlinson, Benjamin

AU - Patel, Farzana

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AU - Kane, Ingrid

AU - Rajkumar, Chakravarthi

AU - Gaylard, Jane

AU - Breeds, Joanna

AU - Gainsborough, Nicola

AU - Pitt-Ford, Alexandra

AU - Barbon, Emma

AU - Latter, Laura

AU - Thompson, Philip

AU - Hervey, Simon

AU - Krishnamoorthy, Shrivakumar

AU - Vassallo, Joseph

AU - Walter, Deborah

AU - Cochrane, Helen

AU - Srinivasan, Meena

AU - Campbell, Robert

AU - Donaldson, Denise

AU - Motherwell, Nichola

AU - Hurford, Frances

AU - Mukherjee, Indranil

AU - Kenton, Antony

AU - Nyabadza, Sheila

AU - Martin, Irene

AU - Hunt, Benjamin

AU - Hassan, Hardi

AU - O'Toole, Sarah

AU - Dallol, Bander

AU - Putterill, Janet

AU - Jha, Ratneshwari

AU - Gallifent, Rachel

AU - Kakar, Puneet

AU - Pusalkar, Aparna

AU - Chan, kelly

AU - Dangri, Puneet

AU - Beadle, Hannah

AU - Cook, Angela

AU - Crabtree, Karen

AU - Subramonian, Santhosh

AU - Owusu-Agyei, Peter

AU - Temple, Natalie

AU - Butterworth-Cowin, Nicola

AU - Ragab, Suzanne

AU - Knops, Kerstin

AU - Jinks, Emma

AU - Dickson, Christine

AU - Gleave, Laura

AU - Dube, Judith

AU - Leggett, Jacqui

AU - Garcia, Tatiana

AU - Ispoglou, Sissy

AU - Evans, Rachel

AU - Ankolekar, Sandeep

AU - Hayes, Anne

AU - Ni, Hlaing

AU - Rahman, Bithi

AU - Milligan, Josette

AU - Graham, Carol

AU - Jose, Josin

AU - Keegan, Breffni

AU - Kelly, Jim

AU - Dewar, Richard

AU - White, James

AU - Thomas, Kelly

PY - 2019/7

Y1 - 2019/7

N2 - Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627. Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05). Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision. Funding: British Heart Foundation.

AB - Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627. Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05). Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision. Funding: British Heart Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85067016486&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067016486&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(19)30184-X

DO - 10.1016/S1474-4422(19)30184-X

M3 - Article

C2 - 31129065

AN - SCOPUS:85067016486

VL - 18

SP - 643

EP - 652

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 7

ER -