# Differential Effects of Pre-Stroke Antithrombotic Medication on Clinical Outcomes of Patients with Hyperhomocysteinemia and First-Ever Stroke Versus Recurrent Stroke

## TL;DR

High homocysteine levels and not taking blood thinners before a first stroke are linked to worse outcomes, but this effect is not seen in people with recurring strokes.

## Contribution

The study reveals that pre-stroke antithrombotic medication interacts with hyperhomocysteinemia to influence outcomes differently in first-ever versus recurrent stroke patients.

## Key findings

- Hyperhomocysteinemia was linked to worse outcomes (aOR 1.32) in ischemic stroke patients.
- Not using antithrombotic medication before a first stroke was associated with worse outcomes (aOR range 1.45–1.64).
- This association was not observed in patients with recurrent strokes (aOR range 0.70–1.04).

## Abstract

Background/Objectives: The associations between plasma homocysteine and pre-stroke antithrombotic medication and the effects these have on clinical outcomes of patients undergoing ischemic stroke remains unclear. This study aimed to evaluate the combined effect of plasma homocysteine levels and the use of pre-stroke antithrombotic medication on the clinical outcomes of patients experiencing first-ever and recurrent ischemic strokes. Methods: Anonymized data from consecutive patients who experienced ischemic stroke and had their plasma homocysteine levels evaluated were retrospectively analyzed. Pre-stroke antithrombotic medication status, clinical variables potentially influencing homocysteine concentrations, and stroke recurrence data were collected. Clinical outcomes were assessed using the modified Rankin Scale 3 months after stroke onset. The association between hyperhomocysteinemia and clinical outcomes was evaluated using logistic regression models. Results: Hyperhomocysteinemia was significantly associated with unfavorable clinical outcomes (adjusted odds ratio [aOR], 1.32; 95% confidence interval, 1.04–1.69) in the 2767 patients who were analyzed. The absence of pre-stroke antithrombotic medication use was associated with unfavorable outcomes (aOR range, 1.29–1.56), specifically in patients with first-ever stroke (aOR range, 1.45–1.64) but not in patients with recurrent strokes (aOR range, 0.70–1.04). Conclusions: Hyperhomocysteinemia and non-use of pre-stroke antithrombotic medication were significantly related to unfavorable outcomes in patients experiencing their first-ever stroke. These findings might provide prognostic insights into stroke management and patient stratification.