Title : Major stroke adverse events of dual versus single antiplatelet therapy in acute and subacute ischemic stroke patient outcomes: A retrospective cohort analysis
Abstract:
Introduction: Short-term use of dual antiplatelet therapy (DAPT) has been shown to be superior to single antiplatelet therapy (SAPT) in improving outcomes in patients with acute ischemic stroke (AIS). However, long-term effects following SAPT and DAPT remain unclear. This study aimed to investigate the long-term impact of DAPT and SAPT on the clinical outcomes of AIS patients.
Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City facilities in Riyadh and Jeddah, and Prince Mohammed bin Abdulaziz Hospital in Madinah, and included 912 AIS patients who received either DAPT (aspirin plus clopidogrel) or SAPT (aspirin or clopidogrel alone). The primary outcome was the incidence of net adverse clinical and cerebral events (NACCEs), defined as the incidence of any hemorrhagic transformation within 30 days or stroke recurrence and/or all-cause mortality within 12 months of the index stroke.
Results: Of the 4043 patients screened, 912 met the inclusion criteria, with a mean age of 65.21 years. Among them, 582 patients (63.8%) received DAPT. There was no statistically significant difference in the incidence of NACCEs between the DAPT and SAPT groups over 12 months (p = 0.946). Although the DAPT group showed a higher rate of stroke recurrence 50 days after the index stroke, this difference was not statistically significant (p = 0.107). Similarly, the SAPT group had a slightly higher incidence of mortality after 6 months and hemorrhagic transformation within 5 days, but these were also not statistically significant (p = 0.312 and 0.214, respectively).
Conclusion: Addition of a second antiplatelet agent did not significantly affect the long-term risk of stroke recurrence or mortality in AIS patients over a 12-month period. Prospective studies are needed to clarify the long-term benefits and risks of DAPT compared with SAPT in different stroke subpopulations.
