A REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack (READAPT)
Authors: 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 , Morau 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 , Diamanti Susanna , Tarletti Roberto , Nencini Patrizia , Rota Eugenia , Sepe Federica Nicoletta , Ferrandi Delfina , Caputi Luigi , Volpi Gino , Spada Salvatore La , Beccia Mario , Rinaldi Claudia , Mastrangelo Vincenzo , Blasio Francesco Di , Invernizzi Paolo , Pelliccioni Giuseppe , De Angelis Maria Vittoria , Bonanni Laura , Ruzza Giampietro , Caggia Emanuele Alessandro , Russo Monia , Tonon Agnese , Acciarri Maria Cristina , Anticoli Sabrina , Roberti Cinzia , Manobianca Giovanni , Scaglione Gaspare , Pistoia Francesca , Fortini Alberto , De Boni Antonella , Sanna Alessandra , Chiti Alberto , Barbarini Leonardo , Caggiula Marcella , Masato Maela , Del Sette Massimo , Passarelli Francesco , Bongioanni Maria Roberta , Toni Danilo , Ricci Stefano , Sacco Simona ,   the READAPT Study Group
Published: January 2024

Background and purpose

Clinical trials proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). In clinical practice, the use of short-term DAPT is broader than in clinical trials and procedures of clinical trials (i.e. loading dose, timely treatment start) are not always followed. We aimed at evaluating effectiveness and safety of short-term DAPT in real-world.

Methods

READAPT (A 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. The enrollment closed on 28thFebruary 2023. We included patients aged 18+ receiving DAPT after minor ischemic stroke or high-risk TIA but no stringent exclusion criteria were applied regarding stroke severity and ABCD2score. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Key secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment.

Results

We included 1920 patients; the majority started DAPT after an ischemic stroke (69.9%) rather than a TIA. 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. We compared different subgroups of patients and we found significant differences among patients with NIHSS score ≤5 and those without acute lesions at neuroimaging who had higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start after 24 hours from symptom onset was associated with a lower likelihood of bleeding.

Conclusions

Short-term DAPT after ischemic stroke or TIA is effective and safe in real-world where a broader population receives the treatment and procedures may differ from clinical trials.