What does this research mean for the field?

In patients with acute mild-to-moderate ischemic stroke receiving dual antiplatelet therapy, early neurological deterioration is independently predicted by earlier presentation and treatment initiation, higher admission systolic blood pressure, and small artery occlusion or cardioembolic stroke etiology. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to identify predictors of early neurological deterioration (END) in stroke patients despite dual antiplatelet therapy.

June 25, 2026Therapeutic Advances in Neurological DisordersOpen Access

Residual early neurological deterioration following dual antiplatelet in stroke: post hoc analysis of the ATAMIS trial

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Why the study?

A significant proportion of patients experience early neurological deterioration despite DAPT for acute ischemic stroke, making it crucial to identify predictors for risk stratification and targeted intervention.

Population

1,122 patients with acute mild-to-moderate ischemic stroke treated with DAPT

Comparison

Patients with early neurological deterioration vs non-early neurological deterioration

Design

Post hoc analysis of the ATAMIS trial

Follow-up

7 days

Authors

YCYu CuiQingdao University XKXiangru KongWuhan Wudong Hospital JZJ ZhangDalian Medical University

Discussion

Member takes

Implication

Shorter onset-to-treatment and higher SBP associate with END on DAPT; leaves open whether modifying these reduces deterioration in mild stroke.

Key Points

This analysis aims to identify predictors of early neurological deterioration (END) in stroke patients despite dual antiplatelet therapy.
Conducted a post hoc analysis of the ATAMIS trial with 1,122 patients receiving DAPT.
Classified patients into END and Non-END groups based on NIHSS changes.
Identified independent predictors using multivariable logistic regression.
5.9% (66 patients) experienced early neurological deterioration within 7 days.
Shorter time to antiplatelet initiation was associated with lower END risk (aOR per hour, 0.97; 95% CI, 0.95–0.99; p=0.01).
Higher admission systolic blood pressure increased END risk (aOR per mmHg, 1.01; 95% CI, 1.00–1.02; p=0.047).

Structured PICO

Population

1,122 patients with acute mild-to-moderate ischemic stroke treated with dual antiplatelet therapy (clopidogrel plus aspirin) from the ATAMIS trial

Intervention

Dual antiplatelet therapy (clopidogrel plus aspirin)

Outcome

Early neurological deterioration (END), defined as an increase of ⩾2 points within 7 days from baseline on the National Institutes of Health Stroke Scale (NIHSS)hard clinical

In patients with mild-to-moderate ischemic stroke on DAPT, very early presentation, elevated admission systolic blood pressure, and non-large artery atherosclerosis etiology predict early neurological deterioration.

Cite This Study

Cui et al. (2026) studied this question.

synapsesocial.com/papers/6a3d91bf408ebb922448b17c https://doi.org/10.1177/17562864261461421

Topics

Dual antiplatelet therapy

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Implication

Shorter onset-to-treatment and higher SBP associate with END on DAPT; leaves open whether modifying these reduces deterioration in mild stroke.

Residual early neurological deterioration following dual antiplatelet in stroke: post hoc analysis of the ATAMIS trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Residual early neurological deterioration following dual antiplatelet in stroke: post hoc analysis of the ATAMIS trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider