Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack

被引：8

作者：

De Matteis, Eleonora ^{[1
,2
]}

Ornello, Raffaele ^{[1
]}

De Santis, Federico ^{[1
]}

Foschi, Matteo ^{[1
]}

Romoli, Michele ^{[3
]}

Tassinari, Tiziana ^{[4
]}

Saia, Valentina ^{[4
]}

Cenciarelli, Silvia ^{[5
]}

Bedetti, Chiara ^{[5
]}

Padiglioni, Chiara ^{[5
]}

Censori, Bruno ^{[6
]}

Puglisi, Valentina ^{[6
]}

Vinciguerra, Luisa ^{[6
]}

Guarino, Maria ^{[7
]}

Barone, Valentina ^{[7
]}

Zedde, Marialuisa ^{[8
]}

Grisendi, Ilaria ^{[8
]}

Diomedi, Marina ^{[9
]}

Bagnato, Maria Rosaria ^{[9
]}

Petruzzellis, Marco ^{[10
,11
]}

Mezzapesa, Domenico Maria ^{[10
,11
]}

Di Viesti, Pietro ^{[12
]}

Inchingolo, Vincenzo ^{[12
]}

Cappellari, Manuel ^{[13
]}

Zenorini, Mara ^{[13
]}

Candelaresi, Paolo ^{[14
,15
]}

Andreone, Vincenzo ^{[14
,15
]}

Rinaldi, Giuseppe ^{[16
]}

Bavaro, Alessandra ^{[16
]}

Cavallini, Anna ^{[17
,18
]}

Moraru, Stefan ^{[17
,18
]}

Querzani, Pietro ^{[19
]}

Terruso, Valeria ^{[20
]}

Mannino, Marina ^{[20
]}

Pezzini, Alessandro ^{[21
]}

Frisullo, Giovanni ^{[22
]}

Muscia, Francesco ^{[23
]}

Paciaroni, Maurizio ^{[24
]}

Mosconi, Maria Giulia ^{[24
]}

Zini, Andrea ^{[25
,26
]}

Leone, Ruggiero ^{[27
,28
]}

Palmieri, Carmela ^{[29
]}

Cupini, Letizia Maria ^{[30
,31
]}

Marcon, Michela ^{[32
]}

Tassi, Rossana ^{[33
]}

Sanzaro, Enzo ^{[34
]}

Paci, Cristina ^{[35
]}

Viticchi, Giovanna ^{[36
]}

Orsucci, Daniele ^{[37
,38
]}

Falcou, Anne ^{[39
]}

机构：

[1] Univ LAquila, Dept Biotechnol & Appl Clin Sci, Via Vetoio 1, I-67100 Laquila, Abruzzo, Italy

[2] Imperial Coll London, Dept Brain Sci, London, England

[3] AUSL Romagna, Maurizio Bufalini Hosp, Dept Neurosci, Cesena, Italy

[4] Santa Corona Hosp, Dept Neurol, Pietra Ligure, Italy

[5] Citta Castello Hosp, Dept Neurol, Citta Di Castello, Italy

[6] ASST Cremona Hosp, Dept Neurol, Cremona, Italy

[7] IRCCS Ist Sci Neurol Bologna, Bologna, Italy

[8] Azienda Unita Sanitaria Locale IRCCS Reggio Emili, Neurol Unit, Stroke Unit, Reggio Emilia, Italy

[9] Tor Vergata Univ Hosp, Dept Syst Med, Rome, Italy

[10] F Puca AOU Consorziale Policlinico, Dept Neurol, Bari, Italy

[11] F Puca AOU Consorziale Policlinico, Stroke Unit, Bari, Italy

[12] Fdn IRCCS Casa sollievo Sofferenza, Dept Neurol, San Giovanni Rotondo, Italy

[13] Azienda Osped Univ Integrata Verona, Dept Neurosci, Verona, Italy

[14] AORN Antonio Cardarelli, Dept Neurol, Naples, Italy

[15] AORN Antonio Cardarelli, Stroke Unit, Naples, Italy

[16] Di Venere Hosp, Dept Neurol, Bari, Italy

[17] IRCCS Mondino Fdn, UO Neurol Urgenza, Pavia, Italy

[18] IRCCS Mondino Fdn, Stroke Unit, Pavia, Italy

[19] AUSL Romagna, S Maria Croci Hosp, Dept Neurosci, Ravenna, Italy

[20] AOOR Villa Sofia Cervello, Dept Neurol, Palermo, Italy

[21] Univ Parma, Parma Univ Hosp, Dept Emergency, Stroke Care Program, Parma, Italy

[22] Fdn Policlin Univ Agostino Gemelli, Neurosci Organi Senso & Torace, Rome, Italy

[23] ASST Ovest Milanese, Dept Neurol, Legnano, Italy

[24] Univ Hosp Santa Maria Misericordia, Dept Internal & Cardiovasc Med, Stroke Unit, Perugia, Italy

[25] IRCCS Ist Scienze Neurol Bologna, Maggiore Hosp, Dept Neurol, Bologna, Italy

[26] IRCCS Ist Scienze Neurol Bologna, Maggiore Hosp, Stroke Ctr, Bologna, Italy

[27] MR Dimiccoli Gen Hosp, Dept Neurol, Barletta, Italy

[28] MR Dimiccoli Gen Hosp, Stroke Unit, Barletta, Italy

[29] E Agnelli Hosp Local Hlth Co ASL TO3, Dept Med, Pinerolo, Italy

[30] S Eugenio Hosp, Dept Neurol, Rome, Italy

[31] S Eugenio Hosp, Stroke Unit, Rome, Italy

[32] Cazzavillan Hosp Arzignano, Dept Neurol, Vicenza, Italy

[33] Azienda Osped Univ Senese, Urgency & Emergency Dept, Stroke Unit, Siena, Italy

[34] Umberto I Hosp, Dept Neurol, Siracusa, Italy

[35] Osped Madonna Soccorso, UOC Neurol, San Benedetto Tronto, Italy

[36] Marche Polytech Univ, Expt & Clin Med Dept, Ancona, Italy

[37] San Luca Hosp, Unit Neurol, Lucca, Italy

[38] San Luca Hosp, Unit Neurol, Castelnuovo Garfagnana, Italy

[39] Policlinico Umberto I Hosp, Emergency Dept, Stroke Unit, Rome, Italy

[40] Fdn IRCCS San Gerardo Tintori, Dept Neurol, Monza, Italy

[41] Azienda Osped Univ Maggiore Carita, SCDU Neurol, Stroke Unit, Novara, Italy

[42] Careggi Univ Hosp, Stroke Unit, Florence, Italy

[43] San Giacomo Hosp, Dept Neurol, Novi Ligure, Italy

[44] SS Biagio Arrigo Hosp, Dept Neurol, Stroke Unit, Alessandria, Italy

[45] ASST Osped Maggiore Crema, Dept Cardiocerebrovasc Dis, Neurol Stroke Unit, Crema, Italy

[46] San Jacopo Hosp, Dept Neurol, Pistoia, Italy

[47] Antonio Perrino Hosp, Dept Neurol, Brindisi, Italy

[48] St Andrea Hosp, Dept Neurol, Rome, Italy

[49] AUSL Romagna, Infermi Hosp, Neurol Unit, Rimini, Italy

[50] S Spirito Hosp, Stroke Unit, Pescara, Italy

来源：

EUROPEAN STROKE JOURNAL | 2024年 / 9卷 / 04期

关键词：

Dual antiplatelet therapy; ischemic stroke; TIA; aspirin; clopidogrel; ticagrelor; MINOR STROKE; CLOPIDOGREL; ASPIRIN; RISK;

D O I：

10.1177/23969873241255250

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and purpose: Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs. Methods: READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD(2) score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment. Results: We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score 5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24h after symptom onset was associated with a lower likelihood of bleeding. Conclusions: In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.

引用

页码：989 / 999

页数：11

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