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Title: Do P2Y12 receptor inhibitors prescribed poststroke modify the risk of cognitive disorder or dementia? Protocol for a target trial using multiple national Swedish registries
Authors: Hinwood, Madeleine
Nyberg, Jenny
Leigh, Lucy
Gustavsson, Sara
Attia, John
Oldmeadow, Christopher
Ilicic, Marina
Linden, Thomas
Åberg, N. David
Levi, Chris
Spratt, Neil
Carey, Leeanne M.
Pollack, Michael
Johnson, Sarah J.
Kuhn, Georg Hans
Walker, Frederick R.
Nilsson, Michael
Keywords: Science::Medicine
Issue Date: 2022
Source: Hinwood, M., Nyberg, J., Leigh, L., Gustavsson, S., Attia, J., Oldmeadow, C., Ilicic, M., Linden, T., Åberg, N. D., Levi, C., Spratt, N., Carey, L. M., Pollack, M., Johnson, S. J., Kuhn, G. H., Walker, F. R. & Nilsson, M. (2022). Do P2Y12 receptor inhibitors prescribed poststroke modify the risk of cognitive disorder or dementia? Protocol for a target trial using multiple national Swedish registries. BMJ Open, 12(5), e058244-.
Journal: BMJ Open 
Abstract: Introduction: The target of a class of antiplatelet medicines, P2Y12R inhibitors, exists both on platelets and on brain immune cells (microglia). This protocol aims to describe a causal (based on a counterfactual model) approach for analysing whether P2Y12R inhibitors prescribed for secondary prevention poststroke may increase the risk of cognitive disorder or dementia via their actions on microglia, using real-world evidence. Methods and analysis: This will be a cohort study nested within the Swedish National Health and Medical Registers, including all people with incident stroke from 2006 to 2016. We developed directed acyclic graphs to operationalise the causal research question considering potential time-independent and time-dependent confounding, using input from several experts. We developed a study protocol following the components of the target trial approach described by Hernan et al and describe the data structure that would be required in order to make a causal inference. We also describe the statistical approach required to derive the causal estimand associated with this important clinical question; that is, a time-to-event analysis for the development of cognitive disorder or dementia at 1, 2 and 5-year follow-up, based on approaches for competing events to account for the risk of all-cause mortality. Causal effect estimates and the precision in these estimates will be quantified. Ethics and dissemination: This study has been approved by the Ethics Committee of the University of Gothenburg and Confidentiality Clearance at Statistics Sweden with Dnr 937-18, and an approved addendum with Dnr 2019-0157. The analysis and interpretation of the results will be heavily reliant on the structure, quality and potential for bias of the databases used. When we implement the protocol, we will consider and document any biases specific to the dataset and conduct appropriate sensitivity analyses. Findings will be disseminated to local stakeholders via conferences, and published in appropriate scientific journals.
ISSN: 2044-6055
DOI: 10.1136/bmjopen-2021-058244
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © Author(s) (or their employer(s)) 2022. Published by BMJ. Open access. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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