In minor stroke due to small artery occlusion, early neurological deterioration occurred in 9.5%, and DAPT significantly lowered END risk compared to SAPT (OR 0.079; 95% CI 0.007-0.939; p=0.04).
Cohort (n=451)
No
Does DAPT reduce early neurological deterioration compared to SAPT or alteplase in patients with minor stroke caused by small artery occlusion?
In patients with minor stroke due to small artery occlusion, early neurological deterioration occurs in 9.5% of cases, and dual antiplatelet therapy may significantly reduce this risk compared to single antiplatelet therapy or alteplase.
INTRODUCTION: Early neurological deterioration (END) is a forecast factor in poor outcomes in minor strokes. END's prevalence and forecast factors in minor strokes caused by small artery occlusion (SAO) are still unclear. PATIENTS AND METHOD: We retrospectively analyzed 451 patients with minor stroke (NIHSS ≤ 5) caused by SAO hospitalized within an initial 24 h at BachMai Hospital's stroke center. END was defined as conditions with an elevated two or more NIHSS points within an initial 72 h. The primary outcome included the determination of the END incidence. The secondary outcome identified forecast factors for END through multivariate logistic regression analyses, and therapeutic impacts of antiplatelet and thrombolytic treatments. RESULTS: END occurred in 9.5 % (43/451) of patients (62.7 % male, mean age 63.8 ± 11.8 years). Independent forecast included admission SBP ≥ 150 mmHg (OR = 1.99; 95 % CI: 1.01 - 3.94; p = 0.048), diabetes history (OR = 0.58; 95 % CI: 1.05 - 4.33; p = 0.036), admission blood glucose ≥ 14mmol/L (OR = 2.99; 95 % CI: 1.05 - 8.54; p = 0.04), and internal capsule infarction (OR = 2.23; 95 % CI: 1.01 - 4.92; p = 0.048). The patients group admitted within 4.5 h, DAPT has significantly lower END risk compared to SAPT (OR = 0.079; 95 % CI: 0.007 - 0.939; p = 0.04) and altepase (OR = 0.013; 95 % CI: 0.01 - 0.12; p < 0.01). END risk was similar between SAPT and altepase (p = 0.074). DISCUSSION AND CONCLUSION: END is a 9.5 % incidence in minor acute ischemic stroke due to SAO. Independent forecasts are admission SBP and blood glucose, diabetes history, and internal capsule infarction. The DAPT group has significantly lower END risk than the SAPT and alteplase groups.
Nguyen et al. (Fri,) conducted a cohort in Minor stroke caused by small artery occlusion (SAO) (n=451). Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) or alteplase was evaluated on Early neurological deterioration (END) incidence (≥2 NIHSS points increase within 72h). In minor stroke due to small artery occlusion, early neurological deterioration occurred in 9.5%, and DAPT significantly lowered END risk compared to SAPT (OR 0.079; 95% CI 0.007-0.939; p=0.04).