Key result
Dual antiplatelet treatment increased the likelihood of 90-day return to pre-stroke neurological functioning compared to single antiplatelet treatment (87.5% vs 84.4%; RR 1.03, 95% CI 1.01-1.07).
Why the study?
The real-world benefit and risk profile of short-term dual antiplatelet treatment compared to single antiplatelet treatment in mild-to-moderate non-cardioembolic ischemic stroke patients was unclear.
Does early dual antiplatelet treatment improve 90-day return to pre-stroke neurological functioning compared to single antiplatelet treatment in patients with mild-to-moderate non-cardioembolic ischemic stroke?
Cohort (n=2,016)
Yes
Does early dual antiplatelet treatment improve 90-day return to pre-stroke neurological functioning compared to single antiplatelet treatment in patients with mild-to-moderate non-cardioembolic ischemic stroke?
Answers are grounded in this paper and cite their sources.
Early dual antiplatelet therapy appears safe and more effective than single antiplatelet therapy for secondary prevention in real-world patients with mild-to-moderate non-cardioembolic ischemic stroke, extending the benefits seen in landmark trials to a broader population.
BACKGROUND: Short-term dual antiplatelet treatment (DAPT) is superior to single antiplatelet treatment (SAPT) for secondary prevention in non-cardioembolic minor ischemic stroke and high-risk transient ischemic attack (TIA). As the real-world use of DAPT is broader than in trials, it is important to clarify its benefit/risk profile in a diverse population. METHODS: Post hoc analysis of prospectively collected data from the READAPT cohort and three prospective stroke registries including patients with mild-to-moderate (National Institute of Health Stroke Scale (NIHSS) score 0-10) ischemic stroke receiving early DAPT or SAPT. The primary effectiveness outcome was 90-day return to pre-stroke neurological functioning using modified Rankin Scale (mRS) score. Secondary effectiveness outcomes were 90-day mRS shift, new ischemic stroke/TIA, vascular and all-cause death, 24 h early neurological improvement or deterioration. The safety outcome was 90-day intracranial hemorrhage. RESULTS: We matched 1008 patients treated with DAPT and 1008 treated with SAPT. Compared to SAPT, patients treated with DAPT showed higher likelihood of 90-day primary effectiveness outcome (87.5% vs. 84.4%, risk difference 3.1% (95% confidence interval (CI): 0.1%-6.1%); p = 0.047, risk ratio 1.03 (95% CI: 1.01-1.07); p = 0.043) and higher rate of 24-h early neurological improvement (25.3% vs. 15.4%, risk difference 9.9% (95% CI: 6.4%-13.4%); p < 0.001, risk ratio 1.65 (95% CI: 1.37-1.97); p < 0.001). No differences were observed for other study outcomes. Subgroup analysis confirmed benefit of DAPT over SAPT for primary effectiveness outcome in patients with moderate stroke, those treated with intravenous thrombolysis, and those who received antiplatelet loading dose. CONCLUSION: Our findings suggest that DAPT use might be safe and more effective than SAPT even in the real world and in patients who do not strictly fulfill the criteria of landmark large clinical trials.
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Foschi et al. (2024) conducted a cohort in non-cardioembolic mild-to-moderate ischemic stroke (n=2,016). Dual antiplatelet treatment (DAPT) vs. Single antiplatelet treatment (SAPT) was evaluated on 90-day return to pre-stroke neurological functioning using modified Rankin Scale (mRS) score (RR 1.03, 95% CI 1.01-1.07, p=0.043). Dual antiplatelet treatment increased the likelihood of 90-day return to pre-stroke neurological functioning compared to single antiplatelet treatment (87.5% vs 84.4%; RR 1.03, 95% CI 1.01-1.07).
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