Key result
Prior antiplatelet therapy is linked to ~40% higher risk of 90-day recurrent stroke or TIA.
Why the study?
Data regarding the management of patients already taking an antiplatelet when presenting with an ischaemic stroke or transient ischaemic attack are limited.
Does triple antiplatelet therapy compared to guideline antiplatelet therapy reduce recurrent stroke or TIA in patients with acute cerebral ischaemia, and how does prior antiplatelet use affect this?
RCT (n=3,096)
Open-label, blinded-endpoint
1:1
Yes
Does triple antiplatelet therapy compared to guideline antiplatelet therapy reduce recurrent stroke or TIA in patients with acute cerebral ischaemia, and how does prior antiplatelet use affect this?
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In patients with acute ischaemic stroke or TIA, prior antiplatelet use is a marker of brain frailty and higher recurrence risk, but escalating to triple antiplatelet therapy does not improve outcomes compared to guideline therapy.
Background Data regarding management of patients already on an antiplatelet when presenting with an ischaemic stroke or transient ischaemic attack (TIA) are limited. This secondary analysis of the triple antiplatelets for reducing dependency in ischaemic stroke (TARDIS) trial explored clinical outcomes across prior antiplatelet groups. Methods TARDIS was an international prospective-randomised open-label blinded-endpoint trial assessing 30 days of triple vs. guideline antiplatelet therapy in patients with acute ischaemic stroke or TIA. The number of pre-stroke/TIA antiplatelet agents was collected pre-randomisation. The primary outcome was the combined incidence of, and dependency from, any recurrent stroke (using the modified Rankin Scale) or TIA within 90 days analysed using ordinal logistic regression with adjustment for prognostic factors. Baseline imaging features of brain frailty were adjudicated centrally by neuroimaging experts. Results 1080/3096 (34.9%) participants were on an antiplatelet agent prior to their stroke/TIA and were older, more likely to be male, had more co-morbidities and dependency, and more baseline imaging features of brain frailty than those not on prior antiplatelets. They had a higher incidence of, and dependency from, recurrent stroke or TIA at day 90: 86 (8%) vs. 112 (5.6%), adjusted common OR 1.40, 95%CI 1.02–1.92, p = 0.036; the result was neutralised when adjusted for brain frailty. Randomisation to triple vs. guideline therapy did not influence this effect. Conclusions Participants taking prior antiplatelets were frailer and had a higher incidence and severity of recurrent stroke or TIA at 90 days compared with those not on prior antiplatelets prior to adjustment for brain frailty. Trial registration ISRCTN47823388.
Appleton et al. (2026) conducted an RCT in Acute ischaemic stroke or transient ischaemic attack (n=3,096). Prior antiplatelet therapy vs. No prior antiplatelet therapy was evaluated on Combined incidence of, and dependency from, any recurrent stroke or TIA within 90 days (OR 1.40, 95% CI 1.02-1.92, p=0.036). Prior antiplatelet therapy was associated with a higher incidence and severity of recurrent stroke or TIA at 90 days compared to no prior therapy (OR 1.40), though this effect was neutralized after adjusting for baseline brain frailty.
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