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Dual Antiplatelet Therapy in Acute Branch Atheromatous Disease (BAD)-Related Stroke: A Multicenter Propensity-Matched
Haizhou Hu1, Shengde Li1, Yu Zhang2,3
1Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
Insights
Dual antiplatelet therapy (DAPT) showed a numerical trend toward better outcomes for branch atheromatous disease (BAD)-related stroke compared to single antiplatelet therapy (SAPT). DAPT was found to be safe, with no increased bleeding risk observed in this study.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Branch atheromatous disease (BAD) is a significant cause of stroke, but optimal antiplatelet treatment remains unclear.
- Current treatment strategies for BAD-related stroke often involve single antiplatelet therapy (SAPT), with limited evidence on the efficacy of dual antiplatelet therapy (DAPT).
Purpose of the Study:
- To compare the clinical outcomes of dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) in patients experiencing stroke due to branch atheromatous disease (BAD).
- To evaluate the safety and efficacy of DAPT compared to SAPT in achieving excellent functional outcomes post-stroke.
Main Methods:
- A multicenter prospective study involving patients with BAD-related stroke who received either DAPT or SAPT.
- Propensity score matching (PSM) was employed to balance baseline characteristics between the DAPT and SAPT groups.
- Primary efficacy endpoint: excellent outcome (modified Rankin Scale score 0-1 at 90 days); safety endpoint: bleeding events within 7 or 90 days.
Main Results:
- After PSM, 171 patients received DAPT and 112 received SAPT, with well-matched baseline characteristics.
- Excellent outcomes were observed in 79.5% of the DAPT group versus 69.6% of the SAPT group (p=0.059), indicating a numerical trend towards benefit with DAPT.
- No significant differences in other efficacy outcomes were found, and DAPT did not increase bleeding risk.
Conclusions:
- Dual antiplatelet therapy (DAPT) is safe for acute branch atheromatous disease (BAD)-related stroke patients.
- While not statistically superior, DAPT demonstrated a numerical trend towards improved functional outcomes compared to single antiplatelet therapy (SAPT).
- Further research is warranted to confirm the potential benefits of DAPT in BAD-related stroke.
Aims:
The optimal antiplatelet regimen for branch atheromatous disease (BAD)-related stroke remains uncertain. This study aimed to compare the clinical outcomes of dual antiplatelet therapy (DAPT) vs. single antiplatelet therapy (SAPT) in these patients.
Methods:
From the multicenter prospective BAD-study, we collected consecutive patients with BAD who received DAPT and SAPT. Propensity score matching (PSM) was used to balance baseline characteristics. The primary efficacy endpoint was an excellent outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The safety endpoint was bleeding events within 7 or 90 days.
Results:
A total of 449 patients were enrolled in the analysis, with a median age of 60 years and a median National Institutes of Health Stroke Scale score of 3 at admission. After PSM, there were 112 patients in the SAPT group and 171 patients in the DAPT group, with well-balanced baseline characteristics. Excellent outcome occurred in 69.6% of the SAPT group and 79.5% of the DAPT group (odds ratio, 0.590; 95% confidence interval, 0.341 to 1.022; p = 0.059). No significant differences were observed in other efficacy outcomes between the two groups. In exploratory subgroup analysis, no significant treatment-by-subgroup interactions were observed, and after correction for multiple comparisons, no within-subgroup differences remained statistically significant. No increased bleeding risk was observed in DAPT.
Conclusion:
In acute BAD-related stroke, DAPT was safe but not statistically superior to SAPT for excellent functional outcome; however, its numerical trend toward benefit warrants further investigation.
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