DAPT use in POINT-eligible patients with non-cardioembolic ischemic stroke increased from 15.1% to 43.3% (p<0.001) after the POINT publication, though it remained underused overall.
Cohort
No
DAPT remains significantly underutilized in POINT-eligible patients with non-cardioembolic ischemic stroke in clinical practice, particularly among those with prior aspirin use.
Absolute Event Rate: 43.3% vs 15.1%
p-value: p=<0.001
Abstract Background and aims Dual antiplatelet therapy (DAPT) is a cornerstone in secondary prevention of non-cardioembolic ischemic stroke with NIHSS scores of ≤3, but the utilization of DAPT in POINT-eligible patients in clinical practice remains poorly elucidated. We aimed to evaluate the administration of DAPT in POINT-eligible patients, how the POINT publication influenced the use of DAPT, and which factors predict the use of DAPT in POINT-eligible patients after publication in clinical practice. Methods Retrospective, 10-year single-center cohort study including adults with non-cardioembolic ischemic stroke admitted to a Swiss tertiary hospital between 2014 and 2023. Patients were stratified based on original POINT trial criteria. Logistic regression was used to visualize predicted probabilities of receiving DAPT by POINT-eligibility and discharge date, and to identify predictors of DAPT use in POINT-eligible patients. Results Overall, 29.2% received DAPT with aspirin and clopidogrel at any time during hospitalization, while 17.5% were newly started on DAPT during hospitalisation and discharged with it. Among all patients, 54.5% met the POINT-eligibility criteria. DAPT use in POINT-eligible patients increased from 15.1% to 43.3% (p0.001) after POINT publication. A substantial proportion of POINT-eligible patients (76.1%) did not receive DAPT. Prior aspirin use was associated with a lower likelihood of DAPT administration (aOR 0.010, 95%CI 0.001-0.106). Conclusions Every second patient with non-cardioembolic ischemic stroke met the POINT criteria, yet DAPT remained underused despite increased utilization after the publication of POINT. Prior aspirin use was strongly associated with a lower likelihood of DAPT administration, although it should not preclude patients from receiving DAPT when otherwise eligible. Conflict of interest All authors declare no conflicts of interest relevant to this study.
Schärli et al. (2026) conducted a cohort in non-cardioembolic ischemic stroke. Dual antiplatelet therapy (DAPT) vs. Before POINT publication was evaluated on DAPT use in POINT-eligible patients after POINT publication (p=<0.001). DAPT use in POINT-eligible patients with non-cardioembolic ischemic stroke increased from 15.1% to 43.3% (p<0.001) after the POINT publication, though it remained underused overall.