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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Multiple Antiplatelet Therapy in Ischemic Stroke Already on Antiplatelet Agents Based on the Linked Big Data for

Tae Jung Kim1,2, Ji Sung Lee3, Jae Sun Yoon1

  • 1Department of Neurology, Seoul National University Hospital, Seoul, Korea.

Journal of Korean Medical Science
|September 26, 2023
PubMed

Insights

Adding more antiplatelet therapy to single antiplatelet therapy (SAPT) for non-cardioembolic stroke did not lower vascular risks. However, triple antiplatelet therapy significantly increased major bleeding complications in patients already on SAPT.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Optimal antiplatelet strategy for ischemic stroke patients on single antiplatelet therapy (SAPT) is unclear.
  • This study evaluates antiplatelet regimens in patients with non-cardioembolic stroke previously on SAPT.

Purpose of the Study:

  • To assess the impact of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) versus continued SAPT on vascular and safety outcomes at one year.
  • To determine if intensified antiplatelet therapy improves outcomes after non-cardioembolic stroke in patients already on SAPT.

Main Methods:

  • Retrospective analysis of 9,284 patients with acute non-cardioembolic ischemic stroke on SAPT.
  • Patients were stratified into SAPT, DAPT, or TAPT groups based on discharge medication.
  • One-year outcomes included recurrent ischemic stroke, a composite of vascular events and death, and major bleeding.

Main Results:

  • Multiple antiplatelet therapy (DAPT/TAPT) did not significantly reduce the risk of recurrent ischemic stroke or the composite outcome at one year.
  • Triple antiplatelet therapy (TAPT) was associated with a significantly increased risk of major bleeding complications (HR 4.65).
  • Dual antiplatelet therapy (DAPT) showed a non-significant trend towards increased bleeding risk (HR 1.23).

Conclusions:

  • Intensifying antiplatelet therapy beyond SAPT does not improve 1-year vascular outcomes in non-cardioembolic stroke patients.
  • Triple antiplatelet therapy significantly elevates the risk of major bleeding complications in this patient population.
  • The findings suggest that continued SAPT may be a safer strategy for selected patients.
Abstract

Keywords:
Bleeding RiskMultiple Antiplatelet TherapyNon-Cardioembolic StrokeVascular Outcome

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