Ischemic stroke outcome - Racial differences in the trial of danaparoid inacute stroke (TOAST)

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 th erapy and overall stroke outcome. Methods: The authors compared baseline de mographic, medical, stroke, physical examination, CT, laboratory, and neuro logic factors among 292 African-American and 801 white patients who enrolle d in the TOAST study. TOAST compared danaparoid (ORG 10172) with placebo am ong acute ischemic stroke patients who were treated within 24 hours of stro ke onset. Results: African-Americans were younger and more frequently had h ypertension, 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 s ignificant differences between African-Americans and white patients in outc omes at 7 days, overall number of adverse experiences, or occurrence of ser ious bleeds or hemorrhagic transformations. However, there was a trend towa rd a higher rate of favorable outcomes in white patients at 7 days. There w as 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 p ossess 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 presenc e of lacunar infarction are stronger predictors of good outcomes than was a ppreciated previously.