Abstract 273: 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

Introduction Recurrent neurological symptoms after intravenous thrombolysis in acute ischemic stroke (AIS) pose therapeutic challenges, with limited evidence guiding post‐thrombolysis antiplatelet strategies. This study evaluated the safety and efficacy of dual antiplatelet therapy (DAPT) versus aspirin monotherapy (AM) in this population. Methods We conducted a retrospective cohort study using de‐identified electronic health records from the TriNetX US Collaborative Network, comprising over 66 healthcare organizations. Patients aged ≥18 years, diagnosed with AIS, treated with thrombolysis within 4.5 hours, and who developed recurrent neurological symptoms within 1‐30 days were included. Patients were stratified into AM (aspirin alone) and DAPT (aspirin plus clopidogrel) groups. Primary efficacy outcome was recurrent ischemic stroke between 30 and 90 days. Primary safety outcomes were symptomatic intracranial hemorrhage (ICH) and 90‐day all‐cause mortality. Propensity‐score matching and multivariable logistic regression were applied; significance was set at p<0.05. Results Among 2,502 eligible patients, 889 were matched in each group. Recurrent ischemic stroke occurred in 12.2% of the AM group and 12.6% of the DAPT group, showing no significant difference. Symptomatic ICH occurred in approximately 1% of both groups. DAPT was associated with a non‐significant reduction in 90‐day mortality (1.6% vs. 2.5%). Conclusion Among AIS patients with recurrent symptoms after thrombolysis, DAPT does not significantly improve outcomes compared to aspirin alone. Rates of recurrent stroke, symptomatic ICH, and 90‐day mortality were comparable between groups.