PB0037 - Thrombotic Cerebrovascular Outcomes in Patients with Fibromuscular Dysplasia Treated with Antiplatelet Agents or Anticoagulants: A Single-center Experience.

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Natalia Fendrikova Mahlay, MD, RPVI (she/her/hers)

Cardiovascular Medicine Department, Heart, Vascular and Thoracic Institute
Cleveland Clinic
Cleveland, Ohio, United States

Co-Author(s)

RB

Rohan Bhandari

Cardiovascular Division
Washington University
St. Louis, Washington, United States
CJ

Courtney Jennings

Cardiovascular and Metabolic Sciences Department, Lerner Research Institute
Cleveland Clinic
Cleveland, Ohio, United States
AA

Anu Aggarwal

Cardiovascular and Metabolic Sciences Department, Lerner Research Institute
Cleveland Clinic
Cleveland, Ohio, United States
MP

Michael Pham

Cardiovascular Medicine Department, Heart, Vascular and Thoracic Institute
Cleveland Clinic
Cleveland, Ohio, United States
EM

Emily Manning

Case Western Reserve University School of Medicine
Case Western Reserve University
Cleveland, Ohio, United States
MG

Matthew Godwin

Cardiovascular and Metabolic Sciences Department, Lerner Research Institute
Cleveland Clinic
Cleveland, Ohio, United States
MA

Mariya Ali

Cardiovascular and Metabolic Sciences Department, Lerner Research Institute
Cleveland Clinic
Cleveland, Ohio, United States
RB

Robert Burton

Medical Operations Department
Cleveland Clinic
Cleveland, Ohio, United States
JB

James Bena

Department of Quantitative Health Sciences, Lerner Research Institute
Cleveland Clinic
Cleveland, Ohio, United States
SC

Scott J. Cameron

Cardiovascular Medicine Department, Heart, Vascular and Thoracic Institute
Cleveland Clinic
Cleveland, Ohio, United States

Background: Fibromuscular dysplasia (FMD) is an idiopathic, non-atherosclerotic arterial disease disproportionately affecting women. Cerebrovascular FMD is seen in 89% of the patients in US Registry for FMD and 61% in the European/International Registry. Cerebrovascular accidents (CVA) are common with 10% experiencing stroke and 12.3% transient ischemic (TIA) in the U.S. Registry for FMD. Antiplatelet therapy is prescribed for most patients with FMD in spite of the absence of clinical data to prove efficacy.

Aims: We evaluated the impact of antiplatelet and anticoagulant drugs on thrombotic stroke in patients with FMD as well as predictors of stroke risk.

Methods: Retrospective analysis of the clinical features and thrombotic events in propensity-matched patients carrying an ICD-9/ICD-10 code for FMD at Cleveland Clinic from July 2001-April 2022 temporally related to the initiation date of antithrombotic therapy.

Results: During the observational period of 2083 patients (median age 61 years, 1834 (88%) female), 205 (10%) of 1949 patients had thrombotic stroke, and 250 (12%) of 2074 patients had TIA. Thrombotic events in FMD patients were more common with cardiovascular risk factors, heart failure, arterial dissection (stroke only). Antiplatelet medications reduced risk of stroke (32% vs. 5%, p<0.001) and TIA (23.2% vs. 9.8%, p<0.001). Dual antiplatelet therapy (aspirin + clopidogrel) showed 4.4% stroke incidence vs. 5% on aspirin and 14.6% on clopidogrel alone. Dual antiplatelet therapy (aspirin + clopidogrel) demonstrated 9.3% TIA incidence vs. 9.3% on aspirin and 24.1% on clopidogrel alone. The protective effect of antiplatelet therapy was seen irrespective the time it was started. Anticoagulant medications conferred no protection from TIA in FMD (12.2% vs 12.0%, P=0.17) and, by propensity matching, OR=0.71 (95% CI, 0.47-1.08; P=0.11) if started before TIA. Lack of the protective effect of anticoagulants against TIA was seen irrespective when it was started. Propensity matching revealed anticoagulant medications did confer protection against stroke only if started before the stroke occurred: OR=0.50 (95% CI, 0.30-0.85; P=0.011).

Conclusion(s): This may be the first study to evaluate the impact of CVD risk factors and a protective effect of antithrombotic medications on stroke in patients with FMD. FMD is a disease deserving detailed mechanistic studies to abrogate thrombotic events and prospective analysis of the antithrombotic medications in asymptomatic and symptomatic patients with FMD.