Real-world comparison of dual versus single antiplatelet treatment in patients with non-cardioembolic mild-to-moderate ischemic stroke: a propensity matched analysis. in International journal of stroke : official journal of the International Stroke Society / Int J Stroke. 2024 Nov 18:17474930241302991. doi: 10.1177/17474930241302991.
2024
ASL Torino 3
Tipo pubblicazione
Journal Article
Autori/Collaboratori (77)Vedi tutti...
Pistoia F
Department of Neurology, "A. Murri" Hospital, Fermo, Italy.
Scaglione G
Department of Neurology, Ospedale Civile Ss. Giovanni e Paolo, Venezia, Italy. RINGGOLD: 18053
Roberti C
Department of Neurology, St Misericordia Hospital, Rovigo, Italy. RINGGOLD: 18133
et alii...
Abstract
BACKGROUND: Short-term dual antiplatelet treatment (DAPT) is superior to single antiplatelet treatment (SAPT) for secondary prevention in non-cardioembolic minor ischemic stroke and high-risk TIA. As the real-world use of DAPT is broader than in trials, it is important to clarify its benefit/risk profile in a diverse population. METHODS: Post-hoc analysis of prospectively collected data from the READAPT cohort and 3 prospective stroke registries including patients with mild-to-moderate (National Institute of Health Stroke Scale [NIHSS] score 0-10) ischemic stroke receiving early DAPT or SAPT. The primary effectiveness outcome was 90-day return to pre-stroke neurological functioning using modified Rankin Scale (mRS) score. Secondary effectiveness outcomes were 90-day mRS shift, new ischemic stroke/TIA, vascular and all-cause death, 24-h early neurological improvement or deterioration. The safety outcome was 90-day intracranial hemorrhage. RESULTS: We matched 1008 patients treated with DAPT and 1008 treated with SAPT. Compared to SAPT, patients treated with DAPT showed higher likelihood of 90-day primary effectiveness outcome (87.5% versus 84.4%, risk difference 3.1% [95%CI 0.1%-6.1%];p=0.047, risk ratio 1.03 [95%CI 1.01-1.07];p=0.043) and higher rate of 24-h early neurological improvement (25.3% versus 15.4%, risk difference 9.9% [95%CI 6.4%-13.4%];p<0.001, risk ratio 1.65 [95%CI 1.37-1.97];p<0.001). No differences were observed for other study outcomes. Subgroup analysis confirmed benefit of DAPT over SAPT for primary effectiveness outcome in patients with moderate stroke, those treated with intravenous thrombolysis and who received antiplatelet loading dose. CONCLUSIONS: Our findings suggest that DAPT use might be safe and more effective than SAPT even in the real-world and in patients who do not strictly fulfill criteria of landmark large clinical trials.
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PMID : 39555606
DOI : 10.1177/17474930241302991
Keywords
Outcomes; Mild-to-moderate; Ischemic stroke; Dual antiplatelet treatment; Aspirin; Prognosis;