Residual early neurological deterioration following dual antiplatelet in stroke: post hoc analysis of the ATAMIS trial.

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Therapeutic Advances in Neurological Disorders Pub Date : 2026-06-24 eCollection Date: 2026-01-01 DOI:10.1177/17562864261461421

Yu Cui, Xiang-Ru Kong, Jing Zhang, Hui-Sheng Chen

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引用次数: 0

Abstract

Background: A clinically significant proportion of patients experience early neurological deterioration (END) despite receiving dual antiplatelet therapy (DAPT) for acute ischemic stroke. It is crucial to identify this specific population for risk stratification and targeted intervention.

Objectives: To identify predictors for END after DAPT in acute ischemic stroke.

Design: We performed a post hoc analysis of the antiplatelet therapy in acute mild to moderate ischemic stroke (ATAMIS) trial.

Methods: Patients who received DAPT (clopidogrel plus aspirin) in the ATAMIS trial were included, and classified into END and Non-END groups according to whether they experienced END. END was defined as an increase of ⩾2 points within 7 days from baseline on the National Institutes of Health Stroke Scale (NIHSS). Independent predictors were identified using multivariable logistic regression.

Results: Of the 1,122 patients with acute mild-to-moderate ischemic stroke treated with DAPT, 66 (5.9%) developed END within 7 days. Multivariable analysis identified three independent factors associated with increased END risk: a shorter time from symptom onset to antiplatelet initiation (adjusted odds ratio [aOR] per hour, 0.97; 95% CI, 0.95-0.99; p = 0.01), higher admission systolic blood pressure (aOR per mmHg, 1.01; 95% CI, 1.00-1.02; p = 0.047), and a stroke etiology of either small artery occlusion (aOR, 2.24; 95% CI, 1.29-3.89; p = 0.004) or cardioembolism (aOR, 28.36; 95% CI, 1.23-654.11; p = 0.04).

Conclusion: Among patients with mild-to-moderate ischemic stroke receiving DAPT, key predictors of END include very early presentation, elevated systolic blood pressure at admission, and a nonlarge artery atherosclerosis etiology (small artery occlusion or cardioembolism). These findings highlight subgroups that may require intensified monitoring or adjunctive therapeutic strategies beyond standard DAPT.

Trial registration: ClinicalTrials.gov Identifier: NCT02869009.

查看原文本刊更多论文

卒中患者双重抗血小板后残留的早期神经退化：ATAMIS试验的事后分析。

背景：急性缺血性脑卒中患者尽管接受双重抗血小板治疗（DAPT），但仍有相当比例的患者出现早期神经功能恶化（END）。确定这一特定人群进行风险分层和有针对性的干预至关重要。目的：探讨急性缺血性脑卒中DAPT术后END的预测因素。设计：我们对急性轻中度缺血性卒中（ATAMIS）试验中的抗血小板治疗进行了事后分析。方法：纳入ATAMIS试验中接受DAPT（氯吡格雷加阿司匹林）治疗的患者，根据是否发生END分为END组和Non-END组。END被定义为在美国国立卫生研究院卒中量表（NIHSS）上从基线开始的7天内增加大于或等于2个点。使用多变量逻辑回归确定独立预测因子。结果：在接受DAPT治疗的1122例急性轻中度缺血性卒中患者中，66例（5.9%）在7天内发生END。多变量分析确定了与END风险增加相关的三个独立因素：从症状出现到抗血小板启动的时间较短（每小时校正优势比[aOR]， 0.97; 95% CI, 0.95-0.99; p = 0.01），入院时收缩压较高（aOR / mmHg, 1.01; 95% CI, 1.00-1.02; p = 0.047），卒中病因为小动脉闭塞（aOR, 2.24; 95% CI, 1.29-3.89; p = 0.004）或心脏栓塞（aOR, 28.36; 95% CI, 1.23-654.11; p = 0.04）。结论：在接受DAPT治疗的轻中度缺血性卒中患者中，END的关键预测因素包括非常早期的表现、入院时收缩压升高和非大动脉粥样硬化病因（小动脉闭塞或心脏栓塞）。这些发现强调亚组可能需要加强监测或辅助治疗策略超出标准DAPT。试验注册：ClinicalTrials.gov标识符：NCT02869009。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Neurological Disorders CLINICAL NEUROLOGY-

CiteScore

8.30

自引率

1.70%

发文量

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.