1.Bisphenol A release in the saliva of children with Haas expanders
Viviane OLIVEIRA PRADO ; Maria Eugenia QUEIROZ NASSUR ; Israel D. SOUZA ; Paulo NELSON-FILHO ; Karla CARPIO HORTA ; Fábio LOURENÇO ROMANO ; Ana Paula VALLADARES DE ALMEIDA ; Caio Luiz BITENCOURT REIS ; Maria Bernadete SASSO STUANI ; Mirian Aiko NAKANE MATSUMOTO
The Korean Journal of Orthodontics 2025;55(3):176-182
Objective:
Several studies have highlighted the toxic potential of bisphenol A (BPA), however, BPA release from orthopedic devices remains poorly investigated.Therefore, this study aimed to evaluate BPA levels in the saliva of children treated using Haas expanders.
Methods:
Twenty-two children of both sexes aged 6–10 years who required rapid maxillary expansion were recruited. One week after placement of elastics to separate the permanent molars, orthodontic bands were adapted, and maxillary impressions were obtained using alginate impression material. Haas expanders were fabricated using a standardized amount of acrylic resin. The bands were cemented using Transbond Plus Light Cure Band (3M).Saliva samples were collected at five time points: before (T0) and 30 minutes (T1), 24 hours (T2), 1 week (T3), and 1 month (T4) after Haas expander installation.BPA levels were measured using ultra-high-performance liquid chromatography coupled with Tandem Mass Spectrometry. The results were evaluated using oneway analysis of variance with Tukey’s post-hoc test (alpha = 5%).
Results:
BPA levels were below the recommended tolerable daily intake (TDI) at all timepoints;however, salivary BPA levels at T1 (70.324 ng/mL ± 37.05) and at T2 (18.015 ng/mL ± 11.22) were significantly higher compared to that at T0 (0.475 ng/mL ± 0.27) (P < 0.05).
Conclusions
Salivary BPA levels significantly increased 30 minutes and 24 hours after Haas expander installation and return to baseline values after 1 week. BPA levels did not exceed the TDI, suggesting that the use of Haas expanders may be considered safe concerning BPA exposure in children.
2.Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies
Ana Paula PAGANO ; Bruna Ramos da SILVA ; Flávio Teixeira VIEIRA ; Luiz Fernando Meira FILHO ; Sarah A. PURCELL ; John D. LEWIS ; Michelle L. MACKENZIE ; Paula J. ROBSON ; Jennifer E. VENA ; Flávia Moraes SILVA ; Carla M. PRADO
The World Journal of Men's Health 2025;43(2):304-320
Purpose:
Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. The objective of this study was to systematically review the evidence for an association between diabetes and overall, early, or advanced PC risk.
Materials and Methods:
A systematic review with meta-analysis was performed (MEDLINE, EMBASE, and CINAHL) from inception until September 2023. Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
Results:
Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61–0.83, I2=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79–1.13, I2=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77–1.18, I2=98%) at diagnosis. According to GRADE, the evidence certainty was very low.
Conclusions
Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.
3.Biofabricated 3D Intestinal Models as an Alternative to AnimalBased Approaches for Drug Toxicity Assays
Larissa Bueno TOFANI ; Thayná Mendonc ¸a AVELINO ; Rafael Júnior de AZEVEDO ; Giovanna Blazutti ELIAS ; Melissa Dibbernn GANZERLA ; Maiara Ferreira TERRA ; Vanessa Kiraly Thomaz RODRIGUES ; Renata Santos RABELO ; Samarah Vargas HARB ; Ana Carolina Migliorini FIGUEIRA
Tissue Engineering and Regenerative Medicine 2025;22(2):181-194
BACKGROUND:
The main challenge in new drug development is accurately predicting the human response in preclinical models.
METHODS:
In this study, we developed three different intestinal barrier models using advanced biofabrication techniques: (i) a manual model containing Caco-2 and HT-29 cells on a collagen bed, (ii) a manual model with a Caco-2/HT-29 layer on a HDFn-laden collagen layer, and (iii) a 3D bioprinted model incorporating both cellular layers. Each model was rigorously tested for its ability to simulate a functional intestinal membrane.
RESULTS:
All models successfully replicated the structural and functional aspects of the intestinal barrier. The 3D bioprinted intestinal model, however, demonstrated superior epithelial barrier integrity enhanced tight junction formation, microvilli development, and increased mucus production. When subjected to Ibuprofen, the 3D bioprinted model provided a more predictive response, underscoring its potential as a reliable in vitro tool for drug toxicity testing.
CONCLUSION
Our 3D bioprinted intestinal model presents a robust and predictive platform for drug toxicity assessments, significantly reducing the need for animal testing. This model not only aligns with ethical testing protocols but also offers enhanced accuracy in predicting human responses, thereby advancing the field of drug development.
4.Lipid Priming of Adipose Mesenchymal Stromal Cells with Docosahexaenoic Acid: Impact on Cell Differentiation, Senescence and the Secretome Neuroregulatory Profile
Jonas CAMPOS ; Belém SAMPAIO-MARQUES ; Diogo SANTOS ; Sandra BARATA-ANTUNES ; Miguel RIBEIRO ; Sofia C. SERRA ; Tiffany S. PINHO ; João CANTO-GOMES ; Ana MAROTE ; Margarida CORTEZ ; Nuno A. SILVA ; Adina T. MICHAEL-TITUS ; António J. SALGADO
Tissue Engineering and Regenerative Medicine 2025;22(1):113-128
BACKGROUND:
Priming strategies that improve the functionality of MSCs may be required to address issues limiting successful clinical translation of MSC therapies. For conditions requiring high trophic support such as brain and spinal cord injuries, priming MSCs to produce higher levels of trophic factors may be instrumental to facilitate translation of current MSC therapies. We developed and tested a novel molecular priming paradigm using docosahexaenoic acid (DHA) to prime adipose tissue-derived mesenchymal stromal cells (ASCs) to enhance the secretome neuroregulatory potential.
METHODS:
Comprehensive dose–response and time-course assays were carried to determine an optimal priming protocol. Secretome total protein measurements were taken in association with cell viability, density and morphometric assessments. Cell identity and differentiation capacity were studied by flow cytometry and lineage-specific markers. Cell growth was assessed by trypan-blue exclusion and senescence was probed over time using SA-b-gal, morphometry and gene expression. Secretomes were tested for their ability to support differentiation and neurite outgrowth of human neural progenitor cells (hNPCs). Neuroregulatory proteins in the secretome were identified using multiplex membrane arrays.
RESULTS:
Priming with 40 lM DHA for 72 h significantly enhanced the biosynthetic capacity of ASCs, producing a secretome with higher protein levels and increased metabolic viability. DHA priming enhanced ASCs adipogenic differentiation and adapted their responses to replicative senescence induction. Furthermore, priming increased concentrations of neurotrophic factors in the secretome promoting neurite outgrowth and modulating the differentiation of hNPCs.
CONCLUSIONS
These results provide proof-of-concept evidence that DHA priming is a viable strategy to improve the neuroregulatory profile of ASCs.
5.Bisphenol A release in the saliva of children with Haas expanders
Viviane OLIVEIRA PRADO ; Maria Eugenia QUEIROZ NASSUR ; Israel D. SOUZA ; Paulo NELSON-FILHO ; Karla CARPIO HORTA ; Fábio LOURENÇO ROMANO ; Ana Paula VALLADARES DE ALMEIDA ; Caio Luiz BITENCOURT REIS ; Maria Bernadete SASSO STUANI ; Mirian Aiko NAKANE MATSUMOTO
The Korean Journal of Orthodontics 2025;55(3):176-182
Objective:
Several studies have highlighted the toxic potential of bisphenol A (BPA), however, BPA release from orthopedic devices remains poorly investigated.Therefore, this study aimed to evaluate BPA levels in the saliva of children treated using Haas expanders.
Methods:
Twenty-two children of both sexes aged 6–10 years who required rapid maxillary expansion were recruited. One week after placement of elastics to separate the permanent molars, orthodontic bands were adapted, and maxillary impressions were obtained using alginate impression material. Haas expanders were fabricated using a standardized amount of acrylic resin. The bands were cemented using Transbond Plus Light Cure Band (3M).Saliva samples were collected at five time points: before (T0) and 30 minutes (T1), 24 hours (T2), 1 week (T3), and 1 month (T4) after Haas expander installation.BPA levels were measured using ultra-high-performance liquid chromatography coupled with Tandem Mass Spectrometry. The results were evaluated using oneway analysis of variance with Tukey’s post-hoc test (alpha = 5%).
Results:
BPA levels were below the recommended tolerable daily intake (TDI) at all timepoints;however, salivary BPA levels at T1 (70.324 ng/mL ± 37.05) and at T2 (18.015 ng/mL ± 11.22) were significantly higher compared to that at T0 (0.475 ng/mL ± 0.27) (P < 0.05).
Conclusions
Salivary BPA levels significantly increased 30 minutes and 24 hours after Haas expander installation and return to baseline values after 1 week. BPA levels did not exceed the TDI, suggesting that the use of Haas expanders may be considered safe concerning BPA exposure in children.
6.Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies
Ana Paula PAGANO ; Bruna Ramos da SILVA ; Flávio Teixeira VIEIRA ; Luiz Fernando Meira FILHO ; Sarah A. PURCELL ; John D. LEWIS ; Michelle L. MACKENZIE ; Paula J. ROBSON ; Jennifer E. VENA ; Flávia Moraes SILVA ; Carla M. PRADO
The World Journal of Men's Health 2025;43(2):304-320
Purpose:
Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. The objective of this study was to systematically review the evidence for an association between diabetes and overall, early, or advanced PC risk.
Materials and Methods:
A systematic review with meta-analysis was performed (MEDLINE, EMBASE, and CINAHL) from inception until September 2023. Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
Results:
Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61–0.83, I2=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79–1.13, I2=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77–1.18, I2=98%) at diagnosis. According to GRADE, the evidence certainty was very low.
Conclusions
Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.
7.Biofabricated 3D Intestinal Models as an Alternative to AnimalBased Approaches for Drug Toxicity Assays
Larissa Bueno TOFANI ; Thayná Mendonc ¸a AVELINO ; Rafael Júnior de AZEVEDO ; Giovanna Blazutti ELIAS ; Melissa Dibbernn GANZERLA ; Maiara Ferreira TERRA ; Vanessa Kiraly Thomaz RODRIGUES ; Renata Santos RABELO ; Samarah Vargas HARB ; Ana Carolina Migliorini FIGUEIRA
Tissue Engineering and Regenerative Medicine 2025;22(2):181-194
BACKGROUND:
The main challenge in new drug development is accurately predicting the human response in preclinical models.
METHODS:
In this study, we developed three different intestinal barrier models using advanced biofabrication techniques: (i) a manual model containing Caco-2 and HT-29 cells on a collagen bed, (ii) a manual model with a Caco-2/HT-29 layer on a HDFn-laden collagen layer, and (iii) a 3D bioprinted model incorporating both cellular layers. Each model was rigorously tested for its ability to simulate a functional intestinal membrane.
RESULTS:
All models successfully replicated the structural and functional aspects of the intestinal barrier. The 3D bioprinted intestinal model, however, demonstrated superior epithelial barrier integrity enhanced tight junction formation, microvilli development, and increased mucus production. When subjected to Ibuprofen, the 3D bioprinted model provided a more predictive response, underscoring its potential as a reliable in vitro tool for drug toxicity testing.
CONCLUSION
Our 3D bioprinted intestinal model presents a robust and predictive platform for drug toxicity assessments, significantly reducing the need for animal testing. This model not only aligns with ethical testing protocols but also offers enhanced accuracy in predicting human responses, thereby advancing the field of drug development.
8.Lipid Priming of Adipose Mesenchymal Stromal Cells with Docosahexaenoic Acid: Impact on Cell Differentiation, Senescence and the Secretome Neuroregulatory Profile
Jonas CAMPOS ; Belém SAMPAIO-MARQUES ; Diogo SANTOS ; Sandra BARATA-ANTUNES ; Miguel RIBEIRO ; Sofia C. SERRA ; Tiffany S. PINHO ; João CANTO-GOMES ; Ana MAROTE ; Margarida CORTEZ ; Nuno A. SILVA ; Adina T. MICHAEL-TITUS ; António J. SALGADO
Tissue Engineering and Regenerative Medicine 2025;22(1):113-128
BACKGROUND:
Priming strategies that improve the functionality of MSCs may be required to address issues limiting successful clinical translation of MSC therapies. For conditions requiring high trophic support such as brain and spinal cord injuries, priming MSCs to produce higher levels of trophic factors may be instrumental to facilitate translation of current MSC therapies. We developed and tested a novel molecular priming paradigm using docosahexaenoic acid (DHA) to prime adipose tissue-derived mesenchymal stromal cells (ASCs) to enhance the secretome neuroregulatory potential.
METHODS:
Comprehensive dose–response and time-course assays were carried to determine an optimal priming protocol. Secretome total protein measurements were taken in association with cell viability, density and morphometric assessments. Cell identity and differentiation capacity were studied by flow cytometry and lineage-specific markers. Cell growth was assessed by trypan-blue exclusion and senescence was probed over time using SA-b-gal, morphometry and gene expression. Secretomes were tested for their ability to support differentiation and neurite outgrowth of human neural progenitor cells (hNPCs). Neuroregulatory proteins in the secretome were identified using multiplex membrane arrays.
RESULTS:
Priming with 40 lM DHA for 72 h significantly enhanced the biosynthetic capacity of ASCs, producing a secretome with higher protein levels and increased metabolic viability. DHA priming enhanced ASCs adipogenic differentiation and adapted their responses to replicative senescence induction. Furthermore, priming increased concentrations of neurotrophic factors in the secretome promoting neurite outgrowth and modulating the differentiation of hNPCs.
CONCLUSIONS
These results provide proof-of-concept evidence that DHA priming is a viable strategy to improve the neuroregulatory profile of ASCs.
9.Recanalization Outcomes and Procedural Complications in Patients With Acute Ischemic Stroke and COVID-19 Receiving Endovascular Treatment
João Pedro MARTO ; Davide STRAMBO ; George NTAIOS ; Thanh N NGUYEN ; Pawel WRONA ; Simon ESCALARD ; Simona MARCHESELLI ; Ossama Yassin MANSOUR ; Blanca FUENTES ; Malgorzata DOROBEK ; Marta NOWAKOWSKA-KOTAS ; Elena Oana TERECOASA ; Jonathan M. COUTINHO ; Mariana CARVALHO-DIAS ; Patricia CALLEJA ; João SARGENTO-FREITAS ; Ana PAIVA-NUNES ; Martin ŠRÁMEK ; Priyank KHANDELWAL ; Torcato MEIRA ; Mohamad ABDALKADER ; Pascal JABBOUR ; Martin KOVÁŘ ; Oscar AYO-MARTIN ; Patrik MICHEL ; Roman HERZIG ; Anna CZŁONKOWKSA ; Jelle DEMEESTERE ; Raul G. NOGUEIRA ; Alexander SALERNO ; Susanne WEGENER ; Philipp BAUMGARTNER ; Carlo W. CEREDA ; Giovanni BIANCO ; Morin BEYELER ; Marcel ARNOLD ; Emmanuel CARRERA ; Paolo MACHI ; Valerian ALTERSBERGER ; Leo BONATI ; Henrik GENSICKE ; Manuel BOLOGNESE ; Nils PETERS ; Stephan WETZEL ; Marta MAGRIÇO ; João NUNO RAMOS ; Rita MACHADO ; Carolina MAIA ; Egídio MACHADO ; Patrícia FERREIRA ; Teresa PINHO-E-MELO ; André PAULA ; Manuel Alberto CORREIA ; Pedro CASTRO ; Elsa AZEVEDO ; Luís ALBUQUERQUE ; José NUNO-ALVES ; Joana FERREIRA-PINTO ; Torcato MEIRA ; Liliana PEREIRA ; Miguel RODRIGUES ; André ARAÚJO ; Marta RODRIGUES ; Mariana ROCHA ; Ângelo PEREIRA-FONSECA ; Luís RIBEIRO ; Ricardo VARELA ; Sofia MALHEIRO ; Manuel CAPPELLARI ; Cecilia ZIVELONGHI ; Giulia SAJEVA ; Andrea ZINI ; Gentile MAURO ; Forlivesi STEFANO ; Ludovica MIGLIACCIO ; Maria SESSA ; Sara La GIOIA ; Alessandro PEZZINI ; Davide SANGALLI ; Marialuisa ZEDDE ; Rosario PASCARELLA ; Carlo FERRARESE ; Simone BERETTA ; Susanna DIAMANTI ; Ghil SCHWARZ ; Giovanni FRISULLO ; Pierre SENERS ; Candice SABBEN ; Michel PIOTIN ; Benjamin MAIER ; Guillaume CHARBONNIER ; Fabrice VUILLIER ; Loic LEGRIS ; Pauline CUISENIER ; Francesca R. VODRET ; Gaultier MARNAT ; Jean-Sebastien LIEGEY ; Igor SIBON ; Fabian FLOTTMANN ; Gabriel BROOCKS ; Nils-Ole GLOYER ; Ferdinand O. BOHMANN ; Jan Hendrik SCHAEFER ; Christian H. NOLTE ; Heinrich AUDEBERT ; Eberhard SIEBERT ; Marek SYKORA ; Wilfried LANG ; Julia FERRARI ; Lukas MAYER-SUESS ; Michael KNOFLACH ; Elke-Ruth GIZEWSKI ; Jeffrey STOLP ; Lotte J. STOLZE ; Paul J. NEDERKOORN ; Ido VAN-DEN-WIJNGAARD ; Joke DE MERIS ; Robin LEMMEN ; Sylvie DE RAEDT ; Fenne VANDERVORST ; Matthieu Pierre RUTGERS ; Antoine GUILMOT ; Anne DUSART ; Flavio BELLANTE ; Fernando OSTOS ; Guillermo GONZALEZ-ORTEGA ; Paloma MARTÍN-JIMÉNEZ ; Sebastian GARCÍA-MADRONA ; Antonio CRUZ-CULEBRAS ; Rocio VERA ; Maria-Consuelo MATUTE ; María ALONSO-DE-LECIÑANA ; Ricardo RIGUAL ; Exuperio DÍEZ-TEJEDOR ; Soledad PÉREZ-SÁNCHEZ ; Joan MONTANER ; Fernando DÍAZ-OTERO ; Natalia PEREZ-DE-LA-OSSA ; Belén FLORES-PINA ; Lucia MUÑOZ-NARBONA ; Angel CHAMORRO ; Alejandro RODRÍGUEZ-VÁZQUEZ ; Arturo RENÚ ; Francisco HERNANDEZ-FERNANDEZ ; Tomas SEGURA ; Herbert TEJADA-MEZA ; Daniel SAGARRA-MUR ; Marta SERRANO-PONZ ; Thant HLAING ; Isaiah SEE ; Robert SIMISTER ; David J. WERRING ; Espen Saxhaug KRISTOFFERSEN ; Annika NORDANSTIG ; Katarina JOOD ; Alexandros RENTZOS ; Libor ŠIMU˚NE ; Dagmar KRAJÍČKOVÁ ; Antonín KRAJINA ; Robert MIKULÍK ; Martina CVIKOVÁ ; Jan VINKLÁREK ; David ŠKOLOUDÍK ; Martin ROUBEC ; Eva HURTIKOVA ; Rostislav HRUBÝ ; Svatopluk OSTRY ; Ondrej SKODA ; Marek PERNICKA ; Lubomír KOČÍ ; Zuzana EICHLOVÁ ; Martin JÍRA ; Michal PANSKÝ ; Pavel MENCL ; Hana PALOUŠKOVÁ ; Aleš TOMEK ; Petr JANSKÝ ; Anna OLŠEROVÁ ; Roman HAVLÍČEK ; Petr MALÝ ; Lukáš TRAKAL ; Jan FIKSA ; Matěj SLOVÁK ; Michał KARLIŃSK ; Maciej NOWAK ; Halina SIENKIEWICZ-JAROSZ ; Anna BOCHYNSKA ; Tomasz HOMA ; Katarzyna SAWCZYNSKA ; Agnieszka SLOWIK ; Ewa WLODARCZYK ; Marcin WIĄCEK ; Izabella TOMASZEWSKA-LAMPART ; Bartosz SIECZKOWSKI ; Halina BARTOSIK-PSUJEK ; Marta BILIK ; Anna BANDZAREWICZ ; Justyna ZIELIŃSKA-TUREK ; Krystian OBARA ; Paweł URBANOWSKI ; Sławomir BUDREWICZ ; Maciej GUZIŃSKI ; Milena ŚWITOŃSKA ; Iwona RUTKOWSKA ; Paulina SOBIESZAK-SKURA ; Beata ŁABUZ-ROSZAK ; Aleksander DĘBIEC ; Jacek STASZEWSKI ; Adam STĘPIEŃ ; Jacek ZWIERNIK ; Grzegorz WASILEWSKI ; Cristina TIU ; Razvan-Alexandru RADU ; Anca NEGRILA ; Bogdan DOROBAT ; Cristina PANEA ; Vlad TIU ; Simona PETRESCU ; Atilla ÖZCAN-ÖZDEMIR ; Mostafa MAHMOUD ; Hussam EL-SAMAHY ; Hazem ABDELKHALEK ; Jasem AL-HASHEL ; Ismail IBRAHIM ISMAIL ; Athari SALMEEN ; Abdoreza GHOREISHI ; Sergiu SABETAY ; Hana GROSS ; Piers KLEIN ; Kareem EL NAAMANI ; Stavropoula TJOUMAKARIS ; Rawad ABBAS ; Ghada-A MOHAMED ; Alex CHEBL ; Jiangyong MIN ; Majesta HOVINGH ; Jenney-P TSAI ; Muhib-A KHAN ; Krishna NALLEBALLE ; Sanjeeva ONTEDDU ; Hesham-E MASOUD ; Mina MICHAEL ; Navreet KAUR ; Laith MAALI ; Michael ABRAHAM ; Ivo BACH ; Melody ONG ; Denis BABICI ; Ayaz-M. KHAWAJA ; Maryam HAKEMI ; Kumar RAJAMANI ; Vanessa CANO-NIGENDA ; Antonio ARAUZ ; Pablo AMAYA ; Natalia LLANOS ; Akemi ARANGO ; Miguel A. VENCES ; José-Domingo BARRIENTOS ; Rayllene CAETANO ; Rodrigo TARGA ; Sergio SCOLLO ; Patrick YALUNG ; Shashank NAGENDRA ; Abhijit GAIKWAD ; Kwon-Duk SEO ;
Journal of Stroke 2025;27(1):128-132
10.Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis
Alexandros A. POLYMERIS ; Masatoshi KOGA ; Daniel STRBIAN ; Adhiyaman VEDAMURTHY ; Manju KRISHNAN ; Mattia BRANCA ; Thomas HORVATH ; Martina GOELDLIN ; Gek SHIM ; Christoph GUMBINGER ; Liqun ZHANG ; Espen Saxhaug KRISTOFFERSEN ; Philippe DESFONTAINES ; Peter VANACKER ; Angelika ALONSO ; Sven POLI ; Ana Paiva NUNES ; Nicoletta G. CARACCIOLO ; Markus KNEIHSL ; Timo KAHLES ; Daria GIUDICI ; Silja RÄTY ; Marjaana TIAINEN ; Jesse DAWSON ; Urs FISCHER ;
Journal of Stroke 2025;27(2):217-227
Background:
and Purpose Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach.
Methods:
A post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets.
Results:
Among 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66–1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65–1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30–1.08], HRweighted 0.57 [0.30–1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56–6.63], HRweighted 1.88 [0.56–6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1.
Conclusion
Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

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