What does this research mean for the field?

Dual antiplatelet therapy did not significantly reduce the 90-day risk of recurrent ischemic stroke compared to aspirin monotherapy in patients with acute ischemic stroke and recurrent symptoms post-thrombolysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the efficacy and safety of dual antiplatelet therapy versus aspirin monotherapy in acute ischemic stroke patients experiencing recurrent neurological symptoms after intravenous thrombolysis.

May 20, 2026CureusOpen Access

Efficacy and Safety of Dual Antiplatelet Therapy in Acute Ischemic Stroke With Recurrent Symptoms Post-thrombolysis: A Retrospective Cohort Study From the TriNetX US Collaborative Network

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Ischemic Stroke with Recurrent Symptoms Post-thrombolysis (n=1778). Intervention: Dual antiplatelet therapy (aspirin plus clopidogrel) vs. Aspirin monotherapy. Primary outcome: Recurrence of ischemic stroke within 90 days (OR 0.969, 95% CI 0.731-1.285, p=0.8293).

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Key result

DAPT shows no benefit over aspirin for 90-day recurrent ischemic stroke post-thrombolysis.

OR 0.969
95% CI 0.731-1.285
P=0.8293
n=1,778

Why the study?

Recurrent neurological symptoms after thrombolysis in AIS present management challenges due to limited evidence guiding antiplatelet therapy and a lack of standardized recommendations.

Does dual antiplatelet therapy reduce recurrent ischemic stroke in adult patients with acute ischemic stroke and recurrent symptoms post-thrombolysis compared to aspirin monotherapy?

Population

2,502 AIS patients with recurrent symptoms 1 to 30 days post-thrombolysis (889 pairs matched)

Comparison

DAPT (aspirin plus clopidogrel) vs aspirin monotherapy

Design

Retrospective propensity score-matched cohort study across over 66 hospitals

Follow-up

90 days

Authors

CNChukwudi NwoguCarilion Roanoke Memorial Hospital JSJames StupinBiomedical Research Institute DNDean NeutelUniversity of California, Los Angeles

Discussion

Member takes

Implication

Supports equipoise between aspirin monotherapy and DAPT; leaves open need for randomized confirmation.

Key Points

To assess the efficacy and safety of dual antiplatelet therapy versus aspirin monotherapy in acute ischemic stroke patients experiencing recurrent neurological symptoms after intravenous thrombolysis.
Retrospective cohort analysis using electronic health records from the TriNetX US Collaborative Network across more than 66 hospitals between January 2015 and December 2023.
Identified adult patients with acute ischemic stroke treated with thrombolysis within 4.5 hours of onset who developed recurrent symptoms 1 to 30 days post-thrombolysis.
Conducted 1:1 propensity score matching to compare 889 patients receiving aspirin monotherapy against 889 patients receiving dual antiplatelet therapy (aspirin plus clopidogrel).
Recurrent ischemic stroke between 30 and 90 days occurred in 12.2% of the aspirin monotherapy cohort and 12.6% of the dual antiplatelet therapy cohort (OR=0.969; 95% CI: 0.731-1.285; p=0.8293).
The rate of symptomatic intracranial hemorrhage or intracranial hemorrhage was 1.1% in both treatment groups (OR=1.000; 95% CI: 0.414-2.415; p=1.0000).
All-cause 90-day mortality was 2.5% in the aspirin monotherapy group compared with 1.6% in the dual antiplatelet therapy group, showing no statistically significant difference (OR=1.586; 95% CI: 0.806-3.120; p=0.1780).

Study Design

Type

Cohort (n=1,778)

Multicenter

Yes

Structured PICO

Does dual antiplatelet therapy reduce recurrent ischemic stroke in adult patients with acute ischemic stroke and recurrent symptoms post-thrombolysis compared to aspirin monotherapy?

Population

2,502 adult patients aged ≥18 years with acute ischemic stroke (AIS) who underwent thrombolysis within 4.5 hours of symptom onset and developed recurrent neurological symptoms between 1 and 30 days post-thrombolysis.

Intervention

Dual antiplatelet therapy (DAPT: aspirin plus clopidogrel)

Comparator

Aspirin monotherapy (AM)

Outcome

Recurrent ischemic stroke between 30 and 90 dayshard clinical

Main Result

Effect estimate: OR 0.969 (95% CI 0.731-1.285)

Absolute Event Rate: 12.6% vs 12.2%

p-value: p=0.8293

DAPT does not provide a significant advantage over aspirin monotherapy in reducing recurrent stroke or mortality in AIS patients with recurrent symptoms post-thrombolysis.

Limitations

Possibility of selection bias and residual confounding due to variations in antiplatelet dosing and administration protocols across hospitals
Reliance on ICD-10 codes limited the ability to assess serial NIHSS scores during hospitalization or functional outcomes at 90 days using the modified Rankin Scale
Reliance on ICD-10 codes precluded direct identification of recurrent strokes as a distinct clinical event, introducing misclassification bias

Cite This Study

Nwogu et al. (2026) conducted a cohort in Acute Ischemic Stroke with Recurrent Symptoms Post-thrombolysis (n=1,778). Dual antiplatelet therapy (aspirin plus clopidogrel) vs. Aspirin monotherapy was evaluated on Recurrence of ischemic stroke within 90 days (OR 0.969, 95% CI 0.731-1.285, p=0.8293). Dual antiplatelet therapy did not significantly reduce the 90-day risk of recurrent ischemic stroke compared to aspirin monotherapy (12.6% vs 12.2%, OR 0.969) in patients with acute ischemic stroke and recurrent symptoms post-thrombolysis.

synapsesocial.com/papers/6a0d4e9df03e14405aa99dfd https://doi.org/10.7759/cureus.109056

Topics

Dual antiplatelet therapy

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Efficacy and Safety of Dual Antiplatelet Therapy in Acute Ischemic Stroke With Recurrent Symptoms Post-thrombolysis: A Retrospective Cohort Study From the TriNetX US Collaborative Network

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Efficacy and Safety of Dual Antiplatelet Therapy in Acute Ischemic Stroke With Recurrent Symptoms Post-thrombolysis: A Retrospective Cohort Study From the TriNetX US Collaborative Network

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

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