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

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

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Designing Affordable Housing and Olympic Village out of Shipping Containers for Chicago (Semester Unknown) IPRO 339: SustainableStudentHousingFromRecycledShippingContainersIPRO339Poster2F09

As the deadline for determining which city will host the 2016 Olympics draws near, Chicago, along with Madrid, Rio de Janeiro and Tokyo is trying to prove that it should be selected as the Host City. If on October 2nd Chicago is chosen as the Host City for the 2016 Olympics, it will face the enormous task of providing temporary housing for all Olympics and Paralympics participants, including athletes, coaches, organizers and media reporters. Building upon the previous two semesters, our IPRO is proposing an economical and environmentally friendly solution to this challenge. We propose to utilize thousands of old shipping containers that are cluttering up shipping yards all over the Chicago-land area and convert them into a more cost effective alternative to traditional housing units. Since Chicago’s motto for the 2016 Olympics is “the Blue Green Olympics,” which references the way Chicago prides itself in creating sustainable I P R O 3 3 9 solutions, our proposal would only enhance our chances of being selected as the Host City in addition to being a city that thinks “outside of the box.”Deliverable

Designing Affordable Housing and Olympic Village out of Shipping Containers for Chicago (Semester Unknown) IPRO 339: SustainableStudentHousingFromRecycledShippingContainersIPRO339PosterF09

As the deadline for determining which city will host the 2016 Olympics draws near, Chicago, along with Madrid, Rio de Janeiro and Tokyo is trying to prove that it should be selected as the Host City. If on October 2nd Chicago is chosen as the Host City for the 2016 Olympics, it will face the enormous task of providing temporary housing for all Olympics and Paralympics participants, including athletes, coaches, organizers and media reporters. Building upon the previous two semesters, our IPRO is proposing an economical and environmentally friendly solution to this challenge. We propose to utilize thousands of old shipping containers that are cluttering up shipping yards all over the Chicago-land area and convert them into a more cost effective alternative to traditional housing units. Since Chicago’s motto for the 2016 Olympics is “the Blue Green Olympics,” which references the way Chicago prides itself in creating sustainable I P R O 3 3 9 solutions, our proposal would only enhance our chances of being selected as the Host City in addition to being a city that thinks “outside of the box.”Deliverable

Designing Affordable Housing and Olympic Village out of Shipping Containers for Chicago (Semester Unknown) IPRO 339: SustainableStudentHousingFromRecycledShippingContainersIPRO339FinalReportF09

As the deadline for determining which city will host the 2016 Olympics draws near, Chicago, along with Madrid, Rio de Janeiro and Tokyo is trying to prove that it should be selected as the Host City. If on October 2nd Chicago is chosen as the Host City for the 2016 Olympics, it will face the enormous task of providing temporary housing for all Olympics and Paralympics participants, including athletes, coaches, organizers and media reporters. Building upon the previous two semesters, our IPRO is proposing an economical and environmentally friendly solution to this challenge. We propose to utilize thousands of old shipping containers that are cluttering up shipping yards all over the Chicago-land area and convert them into a more cost effective alternative to traditional housing units. Since Chicago’s motto for the 2016 Olympics is “the Blue Green Olympics,” which references the way Chicago prides itself in creating sustainable I P R O 3 3 9 solutions, our proposal would only enhance our chances of being selected as the Host City in addition to being a city that thinks “outside of the box.”Deliverable

Designing Affordable Housing and Olympic Village out of Shipping Containers for Chicago (Semester Unknown) IPRO 339: SustainableStudentHousingFromRecycledShippingContainersIPRO339EthicsF09

As the deadline for determining which city will host the 2016 Olympics draws near, Chicago, along with Madrid, Rio de Janeiro and Tokyo is trying to prove that it should be selected as the Host City. If on October 2nd Chicago is chosen as the Host City for the 2016 Olympics, it will face the enormous task of providing temporary housing for all Olympics and Paralympics participants, including athletes, coaches, organizers and media reporters. Building upon the previous two semesters, our IPRO is proposing an economical and environmentally friendly solution to this challenge. We propose to utilize thousands of old shipping containers that are cluttering up shipping yards all over the Chicago-land area and convert them into a more cost effective alternative to traditional housing units. Since Chicago’s motto for the 2016 Olympics is “the Blue Green Olympics,” which references the way Chicago prides itself in creating sustainable I P R O 3 3 9 solutions, our proposal would only enhance our chances of being selected as the Host City in addition to being a city that thinks “outside of the box.”Deliverable

Designing Affordable Housing and Olympic Village out of Shipping Containers for Chicago (Semester Unknown) IPRO 339: SustainableStudentHousingFromRecycledShippingContainersIPRO339MidTermPresentationF09

As the deadline for determining which city will host the 2016 Olympics draws near, Chicago, along with Madrid, Rio de Janeiro and Tokyo is trying to prove that it should be selected as the Host City. If on October 2nd Chicago is chosen as the Host City for the 2016 Olympics, it will face the enormous task of providing temporary housing for all Olympics and Paralympics participants, including athletes, coaches, organizers and media reporters. Building upon the previous two semesters, our IPRO is proposing an economical and environmentally friendly solution to this challenge. We propose to utilize thousands of old shipping containers that are cluttering up shipping yards all over the Chicago-land area and convert them into a more cost effective alternative to traditional housing units. Since Chicago’s motto for the 2016 Olympics is “the Blue Green Olympics,” which references the way Chicago prides itself in creating sustainable I P R O 3 3 9 solutions, our proposal would only enhance our chances of being selected as the Host City in addition to being a city that thinks “outside of the box.”Deliverable