Combining Intravenous Thrombolysis and Dual Antiplatelet Treatment in Patients With Minor Ischemic Stroke: A Propensity Matched Analysis of the READAPT Study Cohort
Authors: Ornello Raffaele , Foschi Matteo , De Santis Federico , 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 , Zivelonghi Cecilia , 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 , Beretta Simone , Tarletti Roberto , Nencini Patrizia , Rota Eugenia , Sepe Federica Nicoletta , Ferrandi Delfina , Caputi Luigi , Volpi Gino , La Spada Salvatore , Beccia Mario , Rinaldi Claudia , Mastrangelo Vincenzo , Di Blasio Francesco , 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 , De Matteis Eleonora , Sacco Simona ,   the READAPT Study Group
Published: August 2024

Background
The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS.

Methods and Results

This is a prespecified propensity score‐matched analysis from a prospective multicentric real‐world study (READAPT [Real‐Life Study on Short‐Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90‐day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90‐day risk of stroke and other vascular events and 24‐hour early neurological improvement or deterioration (≥2‐point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI −2.0% to 6.7%];
P
=0.295; risk ratio, 1.03 [95% CI 0.98–1.08];
P
=0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41–0.79];
P
<0.001). Compared with patients treated with DAPT alone, those combining IVT and DAPT had higher 24‐hour early neurological improvement (risk difference, 20.9% [95% CI 13.1%–28.6%]; risk ratio, 1.59 [95% CI 1.34–1.89]; both
P
<0.001) and lower 90‐day risk of stroke and other vascular events (hazard ratio, 0.27 [95% CI 0.08–0.90];
P
=0.034). There were no differences in safety outcomes.

Conclusions
According to findings from this observational study, patients with MIS may benefit in terms of better functional outcome and lower risk of recurrent events from combining IVT and DAPT versus DAPT alone without safety concerns.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT05476081.