Dual antiplatelet Use for extended period taRgeted to AcuTe ischemic stroke with presumed atherosclerotic OrigiN...

Area of Science:

• Neurology
• Cardiology
• Clinical Trials

Background:

• The optimal duration of dual antiplatelet therapy (DAPT) using clopidogrel-aspirin for large artery atherosclerotic (LAA) stroke remains debated.
• Determining the ideal DAPT duration is crucial for balancing recurrent vascular event prevention and bleeding risk.

Purpose of the Study:

• To evaluate if a 12-month DAPT regimen reduces the 1-year risk of recurrent vascular events in patients with LAA stroke compared to a 3-month regimen.
• To assess the safety profile, specifically major bleeding events, associated with longer DAPT duration.

Main Methods:

• A registry-based, multicenter, prospective, randomized, open-label, blinded endpoint study involving 4806 participants.
• Patients with LAA stroke were randomized (1:1) to receive DAPT for 12 months or DAPT for 3 months followed by monotherapy for 9 months.
• The primary efficacy outcome is a composite of stroke, myocardial infarction, and all-cause mortality within 1 year; the primary safety outcome is major bleeding.

Main Results:

• This section is to be filled once the study results are available.
• The study is designed to detect a 22% relative risk reduction in recurrent vascular events with 80% power.

Conclusions:

• This trial will provide critical evidence to guide stroke physicians in selecting the appropriate duration of dual antiplatelet therapy for patients experiencing LAA stroke.
• The findings aim to optimize treatment strategies for LAA stroke patients, potentially reducing long-term morbidity and mortality.