What is the clinical evidence from this study?

Study design: Cohort. Population: Non-cardioembolic ischemic stroke (n=1207). Intervention: Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT). Primary outcome: Very early neurological deterioration (vEND) defined as NIHSS increase ≥4 points within 24 hours (Adjusted risk difference -7.3% (LAA) and 16.6% (non-LAA), p=<0.001).

What does this research mean for the field?

The association between dual antiplatelet therapy and very early neurological deterioration after non-cardioembolic stroke differs by stroke etiology, with a potentially lower risk in large artery atherosclerosis-related strokes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the frequency and determinants of neurological worsening during the first 24 hours after non-cardioembolic ischemic stroke and determine whether the association with dual antiplatelet therapy varies by stroke etiology.

July 31, 2026Cerebrovascular Diseases ExtraOpen Access

Dual Antiplatelet Therapy and Very Early Neurological Deterioration After Non-cardioembolic Stroke According to Stroke Etiology

Q: What are the key findings of this study?

In patients with non-cardioembolic stroke, the association between DAPT and very early neurological deterioration differed by etiology, with a numerically lower risk in LAA stroke and a higher risk in non-LAA stroke (p_interaction < 0.001).

Q: What does this research mean for the field?

The association between dual antiplatelet therapy and very early neurological deterioration after non-cardioembolic stroke differs by stroke etiology, with a potentially lower risk in large artery atherosclerosis-related strokes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the frequency and determinants of neurological worsening during the first 24 hours after non-cardioembolic ischemic stroke and determine whether the association with dual antiplatelet therapy varies by stroke etiology.

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Key result

DAPT ties to lower early neurological deterioration risk only in large-artery stroke, differing by etiology.

Adjusted risk difference -7.3% (LAA) and 16.6% (non-LAA)
P<0.001
n=1,207

Why the study?

Little is known about neurological worsening during the first 24 hours after stroke admission, and the relationship between DAPT and very early neurological deterioration across different stroke etiologies remains unclear.

Does newly initiated dual antiplatelet therapy reduce very early neurological deterioration in adults with non-cardioembolic acute ischemic stroke compared to single antiplatelet therapy?

Population

1,207 consecutive adults with non-cardioembolic ischemic stroke admitted to a Swiss tertiary stroke center

Comparison

Newly initiated DAPT vs SAPT across stroke etiologies (LAA vs non-LAA)

Design

Retrospective single-center cohort study

Follow-up

24 hours

Authors

RPRosa Sruthy Pereppadan SSSabrina SchärliUniversity of St.Gallen SBShania BrülisauerUniversity of St.Gallen

Discussion

Member takes

Implication

DAPT was associated with etiology-specific vEND risk differences; leaves open whether subtype-tailored strategies warrant prospective trials.

Key Points

To assess the frequency and determinants of neurological worsening during the first 24 hours after non-cardioembolic ischemic stroke and determine whether the association with dual antiplatelet therapy varies by stroke etiology.
Retrospective single-center cohort study evaluating 1,207 consecutive adult patients with non-cardioembolic ischemic stroke admitted to a Swiss tertiary stroke center between 2014 and 2023.
Categorized patients by antiplatelet regimen (newly initiated DAPT vs SAPT) and stroke etiology (large artery atherosclerosis [LAA] vs non-LAA), defining very early neurological deterioration (vEND) at 24 hours as an NIHSS increase of ≥4 points (primary) and ≥2 points (secondary).
Estimated adjusted predicted probabilities and risk differences using propensity score-weighted logistic regression with stabilized inverse probability of treatment weights and doubly robust adjustment.
Among 1,207 patients, vEND occurred in 22.2% by the primary definition (NIHSS increase ≥4) and 25.8% by the secondary definition (NIHSS increase ≥2), occurring more frequently in non-LAA than LAA stroke (23.5% vs 17.6%, p=0.04 and 26.4% vs 23.7%, p=0.38, respectively).
The association between antiplatelet strategy and vEND differed significantly by stroke etiology (pinteraction<0.001 for primary; pinteraction=0.007 for secondary definition).
In LAA stroke, DAPT was associated with a numerically lower risk of primary vEND compared with SAPT (adjusted risk difference: -7.3%, 95% CI -16.9% to 2.3%), whereas in non-LAA stroke, DAPT was associated with a higher risk (adjusted risk difference: 16.6%, 95% CI 7.1% to 26.1%).

Study Design

Type

Cohort (n=1,207)

Multicenter

Structured PICO

Does newly initiated dual antiplatelet therapy reduce very early neurological deterioration in adults with non-cardioembolic acute ischemic stroke compared to single antiplatelet therapy?

Population

1,207 adults with non-cardioembolic acute ischemic stroke admitted to a Swiss tertiary center, evaluated for very early neurological deterioration within 24 hours.

Exposure

Newly initiated dual antiplatelet therapy (DAPT) with aspirin and clopidogrel during hospitalization.

Comparator

Single antiplatelet therapy (SAPT) with aspirin or clopidogrel alone.

Outcome

Very early neurological deterioration (vEND) defined as NIHSS increase ≥4 points within 24 hours of admission.hard clinical

Main Result

Effect estimate: Adjusted risk difference -7.3% (LAA) and 16.6% (non-LAA)

p-value: p=<0.001

DAPT may be associated with a lower risk of very early neurological deterioration in LAA stroke but not in non-LAA stroke, highlighting the need for etiology-specific antiplatelet strategies.

Limitations

Retrospective single-center study
Lack of randomized treatment allocation
Residual confounding by indication
Information on antiplatelet loading doses and treatment duration was not available
Treatment classification may reflect clinical decisions made after early neurological worsening
Retrospective single-center design
No randomized treatment allocation
Missing data on loading doses and treatment duration
Potential reverse causality (treatment classification after early worsening)

Cite This Study

Pereppadan et al. (2026) conducted a cohort in Non-cardioembolic ischemic stroke (n=1,207). Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) was evaluated on Very early neurological deterioration (vEND) defined as NIHSS increase ≥4 points within 24 hours (Adjusted risk difference -7.3% (LAA) and 16.6% (non-LAA), p=<0.001). In patients with non-cardioembolic stroke, the association between DAPT and very early neurological deterioration differed by etiology, with a numerically lower risk in LAA stroke and a higher risk in non-LAA stroke (p_interaction < 0.001).

synapsesocial.com/papers/6a6c46e6747664a1aa73bdc2 https://doi.org/10.1159/000552952

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Implication

DAPT was associated with etiology-specific vEND risk differences; leaves open whether subtype-tailored strategies warrant prospective trials.

Dual Antiplatelet Therapy and Very Early Neurological Deterioration After Non-cardioembolic Stroke According to Stroke Etiology

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Dual Antiplatelet Therapy and Very Early Neurological Deterioration After Non-cardioembolic Stroke According to Stroke Etiology

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider