Why the study?
The optimal antiplatelet strategy for patients experiencing an ischemic stroke while already receiving single antiplatelet therapy remained to be elucidated.
Does escalating to dual or triple antiplatelet therapy reduce recurrent stroke or composite vascular outcomes compared to maintaining single antiplatelet therapy in patients with acute non-cardioembolic ischemic stroke who were already on single antiplatelet therapy?
Does escalating to dual or triple antiplatelet therapy reduce recurrent stroke or composite vascular outcomes compared to maintaining single antiplatelet therapy in patients with acute non-cardioembolic ischemic stroke who were already on single antiplatelet therapy?
In patients experiencing a non-cardioembolic stroke while on single antiplatelet therapy, escalating to dual or triple antiplatelet therapy does not reduce 1-year vascular events but increases bleeding risk.
Escalation to DAPT or TAPT was not associated with lower recurrent stroke but TAPT increased bleeding; leaves open whether RCTs would show benefit.
Background : Optimal antiplatelet strategy for patients with ischemic stroke who were already on single antiplatelet therapy (SAPT) remains to be elucidated. This study aimed to evaluate the effect of different antiplatelet regimens on vascular and safety outcomes at 1 year after non-cardioembolic stroke in patients previously on SAPT. Methods: We identified 9,284 patients with acute non-cardioembolic ischemic stroke that occurred on SAPT using linked data. Patients were categorized into three groups according to antiplatelet strategy at discharge: 1) SAPT, 2) dual antiplatelet therapy (DAPT), and 3) triple antiplatelet therapy (TAPT). One-year outcomes included recurrent ischemic stroke, composite outcomes (recurrent ischemic stroke, myocardial infarction, intracerebral hemorrhage, and death), and major bleeding. Results: Of 9,284 patients, 5,565 (59.9%) maintained SAPT, 3,638 (39.2%) were treated with DAPT, and 81 (0.9%) were treated with TAPT. Multiple antiplatelet therapy did not reduce the risks of 1-year recurrent stroke (DAPT, hazard ratio [HR] 1.08 [95%confidence interval, CI, 0.92–1.27], P = 0.339; TAPT, HR, 0.71 [95%CI, 0.27–1.91], P = 0.500) and 1-year composite outcome (DAPT, HR, 1.09 [95%CI, 0.68–1.97], P = 0.592; TAPT HR, 1.46 [95%CI, 0.68–1.97], P = 0.592). However, the TAPT groups showed an increased risk of major bleeding complications (DAPT, HR, 1.23 [95%CI, 0.89–1.71], P = 0.208; TAPT, HR, 4.65 [95%CI, 2.01–10.74], P < 0.001). Conclusions: Additional use of antiplatelet agents in patients with non-cardioembolic ischemic stroke who were already on SAPT did not reduce the 1-year incidence of vascular outcomes, although it increased the risk of bleeding complications.
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Kim et al. (2023) studied this question.
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