Real-world comparison of dual versus single antiplatelet treatment in patients with non-cardioembolic mild-to-moderate ischemic stroke: A propensity matched analysis

被引：2

作者：

Foschi, Matteo ^{[1
]}

Ornello, Raffaele ^{[1
]}

D'Anna, Lucio ^{[2
,3
]}

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

De Santis, Federico ^{[1
]}

Barone, Valentina ^{[4
]}

Viola, Marilina ^{[4
]}

Mosconi, Maria Giulia ^{[5
]}

Rosin, Diletta ^{[6
,7
]}

Romoli, Michele ^{[8
]}

Tassinari, Tiziana ^{[9
]}

Cenciarelli, Silvia ^{[10
]}

Censori, Bruno ^{[11
]}

Zedde, Marialuisa ^{[12
]}

Diomedi, Marina ^{[13
]}

Petruzzellis, Marco ^{[14
]}

Inchingolo, Vincenzo ^{[15
]}

Cappellari, Manuel ^{[16
]}

Candelaresi, Paolo ^{[17
]}

Bavaro, Alessandra ^{[18
]}

Cavallini, Anna ^{[19
]}

Piscaglia, Maria Grazia ^{[20
]}

Terruso, Valeria ^{[21
]}

Pezzini, Alessandro ^{[22
,23
]}

Frisullo, Giovanni ^{[24
]}

Muscia, Francesco ^{[25
]}

Zini, Andrea ^{[26
]}

Leone, Ruggiero ^{[27
]}

Palmieri, Carmela ^{[28
]}

Cupini, Letizia Maria ^{[29
]}

Marcon, Michela ^{[30
]}

Tassi, Rossana ^{[31
]}

Sanzaro, Enzo ^{[32
]}

Papiri, Giulio ^{[33
]}

Viticchi, Giovanna ^{[34
]}

Orsucci, Daniele ^{[35
]}

Falcou, Anne ^{[36
]}

Diamanti, Susanna ^{[37
]}

Tarletti, Roberto ^{[38
]}

Nencini, Patrizia ^{[39
]}

Rota, Eugenia ^{[40
]}

Sepe, Federica Nicoletta ^{[41
]}

Caputi, Luigi ^{[42
]}

Volpi, Gino ^{[43
]}

La Spada, Salvatore ^{[44
]}

Beccia, Mario ^{[45
]}

Mastrangelo, Vincenzo ^{[46
]}

Invernizzi, Paolo ^{[47
]}

Pelliccioni, Giuseppe ^{[48
]}

De Angelis, Maria Vittoria ^{[49
]}

机构：

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

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

[3] Imperial Coll Healthcare NHS Trust, Charing Cross Hosp, Dept Stroke & Neurosci, London, England

[4] IRCCS, Ist Sci Neurolog Bologna, Bologna, Italy

[5] Santa Maria Misericordia Hosp, Dept Diagnost Imaging, Perugia, Italy

[6] Udine Univ Hosp, Clin Neurol, Udine, Italy

[7] Univ Udine, Dipartimento Area Med, Udine, Italy

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

[9] Santa Corona Hosp, Internal Med Gastroenterol Unit, Pietra Ligure, Savona, Italy

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

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

[12] AUSL IRCCS Reggio Emilia, Neurol Unit, Stroke Unit, Reggio Emilia, Italy

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

[14] F Puca AOU Consorziale Policlin, Stroke Unit, Bari, Italy

[15] Casa Sollievo Sofferenza, Dept Neurol, I-71013 San Giovanni Rotondo, Italy

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

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

[18] Di Venere Hosp, Dept Cardiol, Bari, Italy

[19] IRCCS, Mondino Fdn, Neurol Urgenza Stroke Unit, Pavia, Italy

[20] AUSL Romagna, S Maria Croci Hosp, Dept Neurosci, Neurol Unit, Ravenna, Italy

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

[22] Univ Parma, Dept Med & Surg, Parma, Italy

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

[24] Fdn Policlin Univ Agostino Gemelli IRCCS, Dipartimento Neurosci, Rome, Italy

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

[26] IRCCS, Maggiore Hosp, Ist Sci Neurolog Bologna, Bologna, Italy

[27] MR Dimiccoli Hosp, ASL BT, Stroke Unit, Barletta, Italy

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

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

[30] Cazzavillan Hosp, Dept Neurol, Arzignano, Italy

[31] Emergency Dept, Azienda Ospedaliera Universitaria Senese, Siena, Italy

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

[33] Osped Madonna Soccorso, Neurol Unit, San Benedetto Tronto, Italy

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

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

[36] Policlin Umberto I Hosp, Stroke Unit, Rome, Italy

[37] Fdn IRCCS San Gerardo Tintori, Dept Pediat, I-20900 Monza, Italy

[38] Azienda Osped Univ Maggiore Carita, Stroke Unit, Novara, Italy

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

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

[41] SS Biagio & Arrigo, Stroke Unit, Alessandria, Italy

[42] ASST Crema, Dept Cardiocerebrovasc Dis, Crema, Italy

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

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

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

[46] AUSL Romagna, Infermi Hosp, Dept Neurosci, Neurol Unit, Rimini, Italy

[47] Ist Osped Fdn Poliambulanza, Geriatr Dept, Brescia, Italy

[48] IRCCS, Dept Neurol, INRCA, Ancona, Italy

[49] SSpirito Hosp, Stroke Unit, Pescara, Italy

[50] Univ G Annunzio Chieti Pescara, Dipartimento Architettura, Pescara, Italy

来源：

INTERNATIONAL JOURNAL OF STROKE | 2025年 / 20卷 / 04期

关键词：

Ischemic stroke; dual antiplatelet treatment; aspirin; outcomes; prognosis; mild-to-moderate; ASPIRIN; CLOPIDOGREL;

D O I：

10.1177/17474930241302991

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Short-term dual antiplatelet treatment (DAPT) is superior to single antiplatelet treatment (SAPT) for secondary prevention in non-cardioembolic minor ischemic stroke and high-risk transient ischemic attack (TIA). As the real-world use of DAPT is broader than in trials, it is important to clarify its benefit/risk profile in a diverse population. Methods: Post hoc analysis of prospectively collected data from the READAPT cohort and three prospective stroke registries including patients with mild-to-moderate (National Institute of Health Stroke Scale (NIHSS) score 0-10) ischemic stroke receiving early DAPT or SAPT. The primary effectiveness outcome was 90-day return to pre-stroke neurological functioning using modified Rankin Scale (mRS) score. Secondary effectiveness outcomes were 90-day mRS shift, new ischemic stroke/TIA, vascular and all-cause death, 24 h early neurological improvement or deterioration. The safety outcome was 90-day intracranial hemorrhage. Results: We matched 1008 patients treated with DAPT and 1008 treated with SAPT. Compared to SAPT, patients treated with DAPT showed higher likelihood of 90-day primary effectiveness outcome (87.5% vs. 84.4%, risk difference 3.1% (95% confidence interval (CI): 0.1%-6.1%); p = 0.047, risk ratio 1.03 (95% CI: 1.01-1.07); p = 0.043) and higher rate of 24-h early neurological improvement (25.3% vs. 15.4%, risk difference 9.9% (95% CI: 6.4%-13.4%); p < 0.001, risk ratio 1.65 (95% CI: 1.37-1.97); p < 0.001). No differences were observed for other study outcomes. Subgroup analysis confirmed benefit of DAPT over SAPT for primary effectiveness outcome in patients with moderate stroke, those treated with intravenous thrombolysis, and those who received antiplatelet loading dose. Conclusion: Our findings suggest that DAPT use might be safe and more effective than SAPT even in the real world and in patients who do not strictly fulfill the criteria of landmark large clinical trials.

引用

页码：438 / 449

页数：12

共 18 条

[1] Dual Antiplatelet Therapy for the Acute Management and Long-term Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack, An Updated Review [J].

Chan, Bernard P. L. ;

Wong, Lily Y. H. ;

Tan, Benjamin Y. Q. ;

Yeo, Leonard L. L. ;

Venketasubramanian, Narayanaswamy .

JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE, 2024, 11 (02)

[2] Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke [J].

Chen, Hui-Sheng ;

Cui, Yu ;

Wang, Xin-Hong ;

Ma, Yu-Tong ;

Han, Jing ;

Duan, Ying-Jie ;

Lu, Jiang ;

Shen, Li-Ying ;

Liang, Yong ;

Wang, Wei-Zhong ;

Wang, Hui ;

Zhao, Yong ;

Zhang, Jin-Tao ;

Song, Yu-Lin ;

He, Xiao-Mei ;

Li, Run-Hui ;

Tao, Ding-Bo ;

Li, Jing ;

Huang, Shu-Man ;

Wang, Ni ;

Hong, Mei ;

Meng, Chong ;

Zhang, Wei ;

Wang, Duo-Lao ;

Nguyen, Thanh N. .

JAMA NEUROLOGY, 2024, 81 (05) :450-460

[3]

Dawson J., 2022, Eur Stroke J, V7

[4] Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack [J].

De Matteis, Eleonora ;

Ornello, Raffaele ;

De Santis, Federico ;

Foschi, Matteo ;

Romoli, Michele ;

Tassinari, Tiziana ;

Saia, Valentina ;

Cenciarelli, Silvia ;

Bedetti, Chiara ;

Padiglioni, Chiara ;

Censori, Bruno ;

Puglisi, Valentina ;

Vinciguerra, Luisa ;

Guarino, Maria ;

Barone, Valentina ;

Zedde, Marialuisa ;

Grisendi, Ilaria ;

Diomedi, Marina ;

Bagnato, Maria Rosaria ;

Petruzzellis, Marco ;

Mezzapesa, Domenico Maria ;

Di Viesti, Pietro ;

Inchingolo, Vincenzo ;

Cappellari, Manuel ;

Zenorini, Mara ;

Candelaresi, Paolo ;

Andreone, Vincenzo ;

Rinaldi, Giuseppe ;

Bavaro, Alessandra ;

Cavallini, Anna ;

Moraru, Stefan ;

Querzani, Pietro ;

Terruso, Valeria ;

Mannino, Marina ;

Pezzini, Alessandro ;

Frisullo, Giovanni ;

Muscia, Francesco ;

Paciaroni, Maurizio ;

Mosconi, Maria Giulia ;

Zini, Andrea ;

Leone, Ruggiero ;

Palmieri, Carmela ;

Cupini, Letizia Maria ;

Marcon, Michela ;

Tassi, Rossana ;

Sanzaro, Enzo ;

Paci, Cristina ;

Viticchi, Giovanna ;

Orsucci, Daniele ;

Falcou, Anne .

EUROPEAN STROKE JOURNAL, 2024, 9 (04) :989-999

[5] Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke [J].

De Matteis, Eleonora ;

De Santis, Federico ;

Ornello, Raffaele ;

Censori, Bruno ;

Puglisi, Valentina ;

Vinciguerra, Luisa ;

Giossi, Alessia ;

Di Viesti, Pietro ;

Inchingolo, Vincenzo ;

Fratta, Giovanni Matteo ;

Diomedi, Marina ;

Bagnato, Maria Rosaria ;

Cenciarelli, Silvia ;

Bedetti, Chiara ;

Padiglioni, Chiara ;

Tassinari, Tiziana ;

Saia, Valentina ;

Russo, Alessandro ;

Petruzzellis, Marco ;

Mezzapesa, Domenico Maria ;

Caccamo, Martina ;

Rinaldi, Giuseppe ;

Bavaro, Alessandra ;

Paciaroni, Maurizio ;

Mosconi, Maria Giulia ;

Foschi, Matteo ;

Querzani, Pietro ;

Muscia, Francesco ;

Gallo Cassarino, Serena ;

Candelaresi, Paolo ;

De Mase, Antonio ;

Guarino, Maria ;

Cupini, Letizia Maria ;

Sanzaro, Enzo ;

Zini, Andrea ;

La Spada, Salvatore ;

Palmieri, Carmela ;

Sepe, Federica Nicoletta ;

Beretta, Simone ;

Paci, Cristina ;

Caggia, Emanuele Alessandro ;

De Angelis, Maria Vittoria ;

Bonanni, Laura ;

Volpi, Gino ;

Tassi, Rossana ;

Pistoia, Francesca ;

Scoditti, Umberto ;

Tonon, Agnese ;

Viticchi, Giovanna ;

Ruzza, Giampietro .

STROKE, 2023, 54 (05) :1172-1181

[6] Short- and Long-Term Stroke Risk after Urgent Management of Transient Ischaemic Attack: The Bologna TIA Clinical Pathway [J].

Guarino, Maria ;

Rondelli, Francesca ;

Favaretto, Elisabetta ;

Stracciari, Andrea ;

Filippini, Massimo ;

Rinaldi, Rita ;

Zele, Ivana ;

Sartori, Michelangelo ;

Faggioli, Gianluca ;

Mondini, Susanna ;

Donti, Andrea ;

Strocchi, Enrico ;

Esposti, Daniela Degli ;

Muscari, Antonio ;

Veronesi, Maddalena ;

D'Addato, Sergio ;

Spinardi, Luca ;

Faccioli, Luca ;

Trossello, Marco Pastore ;

Cirignotta, Fabio .

EUROPEAN NEUROLOGY, 2015, 74 (1-2) :1-7

[7] Clopidogrel plus aspirin versus aspirin alone for preventing early neurological deterioration in patients with acute ischemic stroke [J].

He, Fan ;

Xia, Cheng ;

Zhang, Jing-Hua ;

Li, Xiao-Qiu ;

Zhou, Zhong-He ;

Li, Feng-Peng ;

Li, Wei ;

Lv, Yan ;

Chen, Hui-Sheng .

JOURNAL OF CLINICAL NEUROSCIENCE, 2015, 22 (01) :83-86

[8] Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA [J].

Johnston, S. Claiborne ;

Amarenco, Pierre ;

Denison, Hans ;

Evans, Scott R. ;

Himmelmann, Anders ;

James, Stefan ;

Knutsson, Mikael ;

Ladenvall, Per ;

Molina, Carlos A. ;

Wang, Yongjun .

NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (03) :207-217

[9] Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA [J].

Johnston, S. Claiborne ;

Easton, J. Donald ;

Farrant, Mary ;

Barsan, William ;

Conwit, Robin A. ;

Elm, Jordan J. ;

Kim, Anthony S. ;

Lindblad, Anne S. ;

Palesch, Yuko Y. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 379 (03) :215-225

[10] 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association [J].

Kleindorfer, Dawn O. ;

Towfighi, Amytis ;

Chaturvedi, Seemant ;

Cockroft, Kevin M. ;

Gutierrez, Jose ;

Lombardi-Hill, Debbie ;

Kamel, Hooman ;

Kernan, Walter N. ;

Kittner, Steven J. ;

Leira, Enrique C. ;

Lennon, Olive ;

Meschia, James F. ;

Nguyen, Thanh N. ;

Pollak, Peter M. ;

Santangeli, Pasquale ;

Sharrief, Anjail Z. ;

Smith, Sidney C., Jr. ;

Turan, Tanya N. ;

Williams, Linda S. .

STROKE, 2021, 52 (07) :E364-E467

← 1 2 →