Real-world comparison of dual versus single antiplatelet treatment in patients with non-cardioembolic mild-to-moderate ischemic stroke: A propensity matched analysis.

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2024-12-16 DOI:10.1177/17474930241302991

Matteo Foschi, Raffaele Ornello, Lucio D'Anna, Eleonora De Matteis, Federico De Santis, Valentina Barone, Marilina Viola, Maria Giulia Mosconi, Diletta Rosin, Michele Romoli, Tiziana Tassinari, Silvia Cenciarelli, Bruno Censori, Marialuisa Zedde, Marina Diomedi, Marco Petruzzellis, Vincenzo Inchingolo, Manuel Cappellari, Paolo Candelaresi, Alessandra Bavaro, Anna Cavallini, Maria Grazia Piscaglia, Valeria Terruso, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Giulio Papiri, Giovanna Viticchi, Daniele Orsucci, Anne Falcou, Susanna Diamanti, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Luigi Caputi, Gino Volpi, Salvatore La Spada, Mario Beccia, Vincenzo Mastrangelo, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Gaspare Scaglione, Francesca Pistoia, Chiara Alessi, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Leonardo Barbarini, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Manuela De Michele, Stefano Ricci, Mariarosaria Valente, Gian Luigi Gigli, Giovanni Merlino, Maurizio Paciaroni, Maria Guarino, Simona Sacco

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引用次数: 0

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 transient ischemic attack (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 three 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% vs. 84.4%, risk difference 3.1% (95% confidence interval (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% vs. 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 those who received antiplatelet loading dose.

Conclusion: 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 the criteria of landmark large clinical trials.

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非心肌栓塞轻度至中度缺血性卒中患者双联抗血小板治疗与单联抗血小板治疗的真实世界比较：倾向匹配分析。

背景：在非心栓性轻微缺血性卒中和高危 TIA 的二级预防中，短期双联抗血小板治疗（DAPT）优于单联抗血小板治疗（SAPT）。由于 DAPT 在现实世界中的应用比试验中更广泛，因此在不同人群中明确其获益/风险情况非常重要：方法：对从 READAPT 队列和 3 个前瞻性卒中登记处收集的前瞻性数据进行事后分析，包括接受早期 DAPT 或 SAPT 的轻中度（美国国立卫生研究院卒中量表 [NIHSS] 评分 0-10 分）缺血性卒中患者。主要疗效指标是使用改良Rankin量表（mRS）评分在90天内恢复到卒中前的神经功能。次要疗效指标为 90 天 mRS 变化、新发缺血性中风/TIA、血管性和全因死亡、24 小时早期神经功能改善或恶化。安全性结果为90天颅内出血：我们对1008名接受DAPT治疗的患者和1008名接受SAPT治疗的患者进行了配对。与 SAPT 相比，接受 DAPT 治疗的患者获得 90 天主要疗效的可能性更高（87.5% 对 84.4%，风险差异为 3.1% [95%CI 0.1%-6.1%]; p=0.047，风险比为 1.03 [95%CI 1.01-1.07];p=0.043），24 小时早期神经功能改善的比率更高（25.3% 对 15.4%，风险差异为 9.9% [95%CI 6.4%-13.4%]; p结论：我们的研究结果表明，DAPT 的使用有助于改善患者的神经功能：我们的研究结果表明，即使在现实世界中，对于不严格符合地标性大型临床试验标准的患者，使用 DAPT 可能比 SAPT 更安全、更有效。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.