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

被引：18

作者：

De Matteis, Eleonora ^{[1
]}

De Santis, Federico ^{[1
]}

Ornello, Raffaele ^{[1
]}

Censori, Bruno ^{[2
]}

Puglisi, Valentina ^{[2
]}

Vinciguerra, Luisa ^{[2
]}

Giossi, Alessia ^{[2
]}

Di Viesti, Pietro ^{[3
]}

Inchingolo, Vincenzo ^{[3
]}

Fratta, Giovanni Matteo ^{[3
]}

Diomedi, Marina ^{[4
]}

Bagnato, Maria Rosaria ^{[4
]}

Cenciarelli, Silvia ^{[5
]}

Bedetti, Chiara ^{[5
]}

Padiglioni, Chiara ^{[5
]}

Tassinari, Tiziana ^{[6
]}

Saia, Valentina ^{[6
]}

Russo, Alessandro ^{[6
]}

Petruzzellis, Marco ^{[7
,8
]}

Mezzapesa, Domenico Maria ^{[7
,8
]}

Caccamo, Martina ^{[7
,8
]}

Rinaldi, Giuseppe ^{[9
]}

Bavaro, Alessandra ^{[9
]}

Paciaroni, Maurizio ^{[10
]}

Mosconi, Maria Giulia ^{[10
]}

Foschi, Matteo ^{[1
,11
]}

Querzani, Pietro ^{[11
]}

Muscia, Francesco ^{[12
]}

Gallo Cassarino, Serena ^{[12
]}

Candelaresi, Paolo ^{[13
,14
]}

De Mase, Antonio ^{[13
,14
]}

Guarino, Maria ^{[15
]}

Cupini, Letizia Maria ^{[16
,17
]}

Sanzaro, Enzo ^{[18
,19
]}

Zini, Andrea ^{[20
,21
]}

La Spada, Salvatore ^{[22
]}

Palmieri, Carmela ^{[23
]}

Sepe, Federica Nicoletta ^{[24
,25
]}

Beretta, Simone ^{[26
]}

Paci, Cristina ^{[27
]}

Caggia, Emanuele Alessandro ^{[28
]}

De Angelis, Maria Vittoria ^{[29
,30
]}

Bonanni, Laura ^{[31
,32
,33
]}

Volpi, Gino ^{[34
]}

Tassi, Rossana ^{[35
]}

Pistoia, Francesca ^{[1
]}

Scoditti, Umberto ^{[36
]}

Tonon, Agnese ^{[37
]}

Viticchi, Giovanna ^{[38
]}

Ruzza, Giampietro ^{[39
]}

机构：

[1] Univ Laquila, Dept Biotechnol & Appl Clin Sci, Laquila, Italy

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

[3] Casa Sollievo Sofferenza, Dept Neurol, San Giovanni Rotondo, Italy

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

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

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

[7] AOU Consorziale Policlin, Dept Neurol, Bari, Italy

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

[9] Venere Hosp, Dept Neurol, Bari, Italy

[10] Univ Hosp Santa Maria Misericordia, Stroke Unit, Perugia, Italy

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

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

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

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

[15] IRCCS Ist Sci Neurolog Bologna, Dept Neurol, Policlin S Orsola Malpighi, Bologna, Italy

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

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

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

[19] Umberto I Hosp, Stroke Unit, Siracusa, Italy

[20] Maggiore Hosp, IRCCS Ist Sci Neurolog Bologna, Dept Neurol, Bologna, Italy

[21] Maggiore Hosp, Stroke Ctr, Bologna, Italy

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

[23] Hosp E Agnelli, Dept Neurol, Pinerolo, Italy

[24] SS Biagio & Arrigo Hosp, Dept Neurol, Alessandria, Italy

[25] SS Biagio & Arrigo Hosp, Stroke Unit, Alessandria, Italy

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

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

[28] Giovanni Paolo II Hosp, Dept Neurol, Ragusa, Italy

[29] SS Annunziata Hosp, Dept Neurol, Chieti, Italy

[30] SS Annunziata Hosp, Stroke Unit, Chieti, Italy

[31] Univ G Annunzio Chieti Pescara, Dipartimento Med & Sci Invecchiamento, Chieti, Italy

[32] Osped Clinicizzato SS Annunziata Chieti, Clin Neurolog, Chieti, Italy

[33] Osped Clinicizzato S S Annunziata Chieti, Sroke Unit, Chieti, Italy

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

[35] Azienda Osped Univ Senese, Stroke Unit, Siena, Italy

[36] Univ Hosp Parma, Dept Emergency Neurol Stroke Care, Parma, Italy

[37] Osped Civile SS Giovanni & Paolo, Dept Neurol, Venice, Italy

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

[39] Cittadella Hosp, Stroke Unit, Cittadella, Italy

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

[41] IRCCS C Mondino Fdn, Dept Emergency Neurol, Pavia, Italy

[42] IRCCS C Mondino Fdn, Stroke Unit, Pavia, Italy

[43] Univ Rome Sapienza, Dept Human Neurosci, Rome, Italy

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

来源：

STROKE | 2023年 / 54卷 / 05期

关键词：

aspirin; clopidogrel; follow-up studies; prospective studies; ticagrelor; OF-HEALTH STROKE; SEX-DIFFERENCES; ASPIRIN; SCALE; CLOPIDOGREL; GUIDELINES;

D O I：

10.1161/STROKEAHA.122.041660

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs.Methods: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the ?(2) test.Results: We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria.Conclusions: The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose.

引用

页码：1172 / 1181

页数：10

共 50 条

[41] Dual antiplatelet treatment for minor acute ischemic stroke and high-risk transient ischemic attack: have we reached the limit of antithrombotic management?
Tsivgoulis, Georgios
Katsanos, Aristeidis H.
EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2022, 100 : 27 - 28
[42] Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke
Xian, Ying
Xu, Haolin
Matsouaka, Roland
Laskowitz, Daniel T.
Maisch, Lesley
Hannah, Deidre
Smith, Eric E.
Fonarow, Gregg C.
Bhatt, Deepak L.
Schwamm, Lee H.
Mac Grory, Brian
Feng, Wuwei
Fosbol, Emil Loldrup
Peterson, Eric D.
Johnson, Mark
JAMA NETWORK OPEN, 2022, 5 (07) : E2224157
[43] Dual antiplatelet treatment in acute ischemic stroke: Translating guidelines into clinical practice
Kollias, Anastasios
Kyriakoulis, Konstantinos G.
Lagou, Styliani
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, 2020, 74 (08)
[44] Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack Meta-Analysis of Randomized Controlled Trials
Bhatia, Kirtipal
Jain, Vardhmaan
Aggarwal, Devika
Vaduganathan, Muthiah
Arora, Sameer
Hussain, Zeeshan
Uberoi, Guneesh
Tafur, Alfonso
Zhang, Cen
Ricciardi, Mark
Qamar, Arman
STROKE, 2021, 52 (06) : e217 - e223
[45] Risk of Stroke after Transient Ischemic Attack or Minor Stroke REPLY
Amarenco, Pierre
NEW ENGLAND JOURNAL OF MEDICINE, 2016, 375 (04) : 387 - 387
[46] Dual or Mono Antiplatelet Therapy for Patients With Acute Ischemic Stroke or Transient Ischemic Attack Systematic Review and Meta-Analysis of Randomized Controlled Trials
Geeganage, Chamila M.
Diener, Hans-Christoph
Algra, Ale
Chen, Christopher
Topol, Eric J.
Dengler, Reinhard
Markus, Hugh S.
Bath, Matthew W.
Bath, Philip M. W.
STROKE, 2012, 43 (04) : 1058 - U262
[47] Balancing Benefits and Risks of Long-Term Antiplatelet Therapy in Noncardioembolic Transient Ischemic Attack or Stroke
Hilkens, Nina A.
Algra, Ale
Diener, Hans Christoph
Bath, Philip M.
Csiba, Laszlo
Hacke, Werner
Kappelle, L. Jaap
Koudstaal, Peter J.
Leys, Didier
Mas, Jean-Louis
Sacco, Ralph L.
Greving, Jacoba P.
STROKE, 2021, 52 (10) : 3258 - 3265
[48] Meta-Analysis of Usefulness of Antiplatelet Therapy in Ischemic Stroke or Transient Ischemic Attack
Medranda, Giorgio A.
Zhang, Cheng
Doros, Gheorghe
Yerasi, Charan
Case, Brian C.
Weintraub, William S.
Waksman, Ron
AMERICAN JOURNAL OF CARDIOLOGY, 2021, 153 : 129 - 134
[49] Dual Antiplatelet Therapy of Clopidogrel and Aspirin in Secondary Prevention of Ischemic Stroke: Evidence and Indications
Su, Ya
Cheng, Xin
Dong, Qiang
CNS NEUROSCIENCE & THERAPEUTICS, 2015, 21 (11) : 870 - 876
[50] Dual antiplatelet therapy after minor strokes or high-risk TIA: Evidence from the Austrian stroke registry
Krebs, Stefan
Miksova, Dominika
Knoflach, Michael
Gattringer, Thomas
Fandler-Hoefler, Simon
Marlen, Fahrner
Marko, Martha
Greisenegger, Stefan
Lang, Wilfried
Ferrari, Julia
Sykora, Marek
EUROPEAN JOURNAL OF NEUROLOGY, 2025, 32 (01)

← 1 2 3 4 5 →