The effectiveness and safety of administering antiplatelet medications following reperfusion therapy in patients with ischemic stroke.

Abstract

Background: Ischemic stroke is a major cause of morbidity and mortality worldwide. Although reperfusion therapy enhances patient outcomes, the ideal antiplatelet regimen post-treatment remains unclear. This study investigates the efficacy and safety of dual antiplatelet therapy (DAPT) versus triple antiplatelet therapy (TAT) in ischemic stroke patients after reperfusion.

Research design and methods: A retrospective observational analysis was conducted on 730 patients treated at a single institution from January 2018 to December 2023. Patients were divided into two groups: DAPT (aspirin and clopidogrel) or TAT (aspirin, clopidogrel, and tirofiban). Outcomes included neurological improvement via NIHSS scores, functional recovery using mRS, and bleeding complications.

Results: TAT demonstrated significantly better neurological recovery, with more patients achieving NIHSS ≤ 3 (p < 0.001). All TAT patients had mRS ≤ 2 at 30 days. However, TAT was associated with higher bleeding rates (37.4% vs. 18.8%, p < 0.05). Intravenous thrombolysis increased bleeding risk (OR = 3.95, 95% CI: 1.26-12.44, p = 0.02).

Conclusion: TAT may enhance neurological recovery but increases bleeding risk. Patient selection and monitoring are crucial, and long-term studies are needed to fully evaluate its risk-benefit profile.