Safety and Efficacy of Dual Antiplatelet versus Single Antiplatelet Therapyafter Intravenous Thrombolysis for Acute Ischemic Stroke

Objective: This study evaluates the safety and efficacy of Dual Antiplatelet Therapy (DAPT) compared to Single Antiplatelet Therapy (SAPT) in Acute Ischemic Stroke (AIS) patients treated with Intravenous Thrombolysis (IVT). Methods: A total of 348 AIS patients who underwent IVT were included and assigned to either SAPT or DAPT groups for comparison. Propensity Score Matching (PSM) was employed to control baseline confounders and to generate 73 matched pairs. Safety outcomes included all bleeding events. Efficacy outcomes included early neurological deterioration or improvement, National Institutes of Health Stroke Scale at 7 days or discharge, modified Rankin Scale, and stroke recurrence at 90 days. Results: Results: Before PSM, the stroke recurrence rate within the 90-day follow-up period was significantly lower in the DAPT group than the SAPT group (0.0% vs. 5.9%, p = 0.028). After PSM, this difference persisted, with no events (0.0%) in the DAPT group versus 5 events (6.8%) in the SAPT group (p = 0.058). However, no significant differences were found between the two groups regarding other efficacy and safety outcomes. Discussion: This study demonstrates that DAPT following IVT is safe and effective, underscoring its role in preventing recurrent stroke. Conclusion: Initiating DAPT 24 hours after IVT was found to be effective in reducing 90-day stroke recurrence without increasing bleeding risk compared to SAPT in patients with AIS.