Dual Antiplatelet Therapy After an Acute Nonminor Stroke

Area of Science:

• Neurology
• Cardiology
• Clinical Medicine

Background:

• Dual antiplatelet therapy (DAPT) is recommended for minor ischemic strokes but carries increased bleeding risks in broader populations.
• Uncertainty exists regarding DAPT's benefit in nonminor stroke patients when continued for 21-90 days.
• This study addresses the efficacy and safety of DAPT versus single antiplatelet therapy (SAPT) in nonminor stroke.

Purpose of the Study:

• To evaluate the effects of DAPT compared to SAPT in patients with nonminor ischemic stroke.
• To assess the risks of major bleeding, recurrent stroke, and transient ischemic attack (TIA) associated with DAPT in this population.

Main Methods:

• Retrospective cohort study of 158 patients with nonminor ischemic stroke treated within 1 week of symptom onset.
• Patients received either DAPT (aspirin plus clopidogrel) or SAPT.
• Primary endpoint: major bleeding at 3 months; secondary endpoints: recurrent stroke/TIA and minor bleeding.

Main Results:

• No significant difference in major bleeding between DAPT (3 patients) and SAPT (1 patient) groups (P=0.463).
• Minor bleeding rates were comparable: 1 patient in DAPT group vs. 2 in SAPT group (P=0.402).
• Recurrent stroke or TIA occurred in 10 DAPT patients versus 5 SAPT patients (P=0.429), with no statistically significant difference.

Conclusions:

• DAPT and SAPT demonstrated comparable risks of bleeding and recurrent stroke in patients with acute nonminor ischemic stroke.
• The findings suggest that DAPT may not offer additional antithrombotic benefits over SAPT in this specific patient group.
• Further research is warranted, acknowledging the limitations of this single-center, retrospective study design.