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Ischemic stroke outcome

Racial differences in the trial of danaparoid in acute stroke (TOAST)

From the Departments of Internal Medicine (Dr. Hassaballa), Neurological Sciences (Dr. Gorelick), Rush Presbyterian St. Luke’s Medical Center, Chicago, IL; Department of Internal Medicine (Dr. West), Mayo Graduate School of Medicine, Rochester, MN; College of Public Health (M. Hansen), University of Iowa, Iowa City; and Department of Neurology (Dr. Adams), Division of Cerebrovascular Diseases, University of Iowa College of Medicine, Iowa City.

Address correspondence and reprint requests to Dr. Hesham Hassaballa, Department of Internal Medicine, Rush Presbyterian St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, IL 60612; e-mail: hhassaba{at}rush.edu

Objective:— To determine racial differences in baseline stroke risk factors and other measures in the Trial of ORG 10172 in Acute Stroke Therapy (TOAST). Differences in these factors could influence response to acute stroke therapy and overall stroke outcome.

Methods:— The authors compared baseline demographic, medical, stroke, physical examination, CT, laboratory, and neurologic factors among 292 African-American and 801 white patients who enrolled in the TOAST study. TOAST compared danaparoid (ORG 10172) with placebo among acute ischemic stroke patients who were treated within 24 hours of stroke onset.

Results:— African-Americans were younger and more frequently had hypertension, diabetes mellitus, congestive heart failure, and prior strokes. In addition, African-Americans had higher mean diastolic blood pressure, more lacunar strokes, and more severe prestroke disability. There were no significant differences between African-Americans and white patients in outcomes at 7 days, overall number of adverse experiences, or occurrence of serious bleeds or hemorrhagic transformations. However, there was a trend toward a higher rate of favorable outcomes in white patients at 7 days. There was no significant difference in very favorable outcome at 3 months between African-American and white patients, but significantly more white patients had favorable outcome at 3 months.

Conclusion:— Although African-Americans possess a number of factors that should predict higher rates of poor stroke outcome after acute therapy, they have the capacity to respond similarly to white patients after acute stroke therapy. Perhaps younger age and presence of lacunar infarction are stronger predictors of good outcomes than was appreciated previously.