Combining Intravenous Thrombolysis and Dual Antiplatelet Treatment in Patients With Minor Ischemic Stroke: A Propensity Matched Analysis of the READAPT Study Cohort-Reference-Cited by-同舟云学术

Combining Intravenous Thrombolysis and Dual Antiplatelet Treatment in Patients With Minor Ischemic Stroke: A Propensity Matched Analysis of the READAPT Study Cohort

Published:2024-08-20 Issue:16 Volume:13 Page:
ISSN:2047-9980
Container-title:Journal of the American Heart Association
language:en
Short-container-title:JAHA

Author:

Ornello Raffaele¹^ORCID,Foschi Matteo¹^ORCID,De Santis Federico¹,Romoli Michele²^ORCID,Tassinari Tiziana³^ORCID,Saia Valentina³^ORCID,Cenciarelli Silvia⁴^ORCID,Bedetti Chiara⁴,Padiglioni Chiara⁴,Censori Bruno⁵^ORCID,Puglisi Valentina⁵^ORCID,Vinciguerra Luisa⁵^ORCID,Guarino Maria⁶^ORCID,Barone Valentina⁶^ORCID,Zedde Marialuisa⁷^ORCID,Grisendi Ilaria⁷^ORCID,Diomedi Marina⁸^ORCID,Bagnato Maria Rosaria⁸^ORCID,Petruzzellis Marco⁹,Mezzapesa Domenico Maria⁹,Di Viesti Pietro¹⁰,Inchingolo Vincenzo¹⁰^ORCID,Cappellari Manuel¹¹^ORCID,Zivelonghi Cecilia¹¹,Candelaresi Paolo¹²^ORCID,Andreone Vincenzo¹²,Rinaldi Giuseppe¹³,Bavaro Alessandra¹³^ORCID,Cavallini Anna¹⁴^ORCID,Moraru Stefan¹⁴,Querzani Pietro¹⁵^ORCID,Terruso Valeria¹⁶,Mannino Marina¹⁶^ORCID,Pezzini Alessandro¹⁷^ORCID,Frisullo Giovanni¹⁸^ORCID,Muscia Francesco¹⁹^ORCID,Paciaroni Maurizio²⁰^ORCID,Mosconi Maria Giulia²⁰^ORCID,Zini Andrea²¹^ORCID,Leone Ruggiero²²^ORCID,Palmieri Carmela²³,Cupini Letizia Maria²⁴^ORCID,Marcon Michela²⁵^ORCID,Tassi Rossana²⁶^ORCID,Sanzaro Enzo²⁷,Paci Cristina²⁸,Viticchi Giovanna²⁹^ORCID,Orsucci Daniele³⁰^ORCID,Falcou Anne³¹,Beretta Simone³²^ORCID,Tarletti Roberto³³,Nencini Patrizia³⁴,Rota Eugenia³⁵^ORCID,Sepe Federica Nicoletta³⁶,Ferrandi Delfina³⁶,Caputi Luigi³⁷^ORCID,Volpi Gino³⁸,La Spada Salvatore³⁹,Beccia Mario⁴⁰,Rinaldi Claudia⁴¹,Mastrangelo Vincenzo⁴¹,Di Blasio Francesco⁴²,Invernizzi Paolo⁴³^ORCID,Pelliccioni Giuseppe⁴⁴^ORCID,De Angelis Maria Vittoria⁴²⁴⁵,Bonanni Laura⁴⁶^ORCID,Ruzza Giampietro⁴⁷^ORCID,Caggia Emanuele Alessandro⁴⁸,Russo Monia⁴⁹,Tonon Agnese⁵⁰^ORCID,Acciarri Maria Cristina⁵¹,Anticoli Sabrina⁵²^ORCID,Roberti Cinzia⁵³,Manobianca Giovanni⁵⁴,Scaglione Gaspare⁵⁴,Pistoia Francesca¹^ORCID,Fortini Alberto⁵⁵^ORCID,De Boni Antonella⁵⁶,Sanna Alessandra⁵⁷,Chiti Alberto⁵⁸^ORCID,Barbarini Leonardo⁵⁹^ORCID,Caggiula Marcella⁵⁹^ORCID,Masato Maela⁶⁰,Del Sette Massimo⁶¹,Passarelli Francesco⁶²,Bongioanni Maria Roberta⁶³,Toni Danilo⁶⁴^ORCID,Ricci Stefano⁴⁶⁵^ORCID,De Matteis Eleonora¹⁶⁶^ORCID,Sacco Simona¹^ORCID,

Affiliation:

1. Department of Biotechnological and Applied Clinical Sciences University of L’Aquila Italy

2. Stroke Unit Maurizio Bufalini Hospital Cesena Italy

3. Department of Neurology Santa Corona Hospital Pietra Ligure Italy

4. Department of Neurology Città di Castello Hospital Città di Castello Italy

5. Department of Neurology ASST Cremona Hospital Cremona Italy

6. IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy

7. Department of Neurology AUSL‐IRCCS di Reggio Emilia Reggio Emilia Italy

8. Department of Systems Medicine Tor Vergata University Hospital Rome Italy

9. Stroke Unit, “F. Puca” AOU Consorziale Policlinico Bari Italy

10. Department of Neurology Casa Sollievo della Sofferenza San Giovanni Rotondo Italy

11. Department of Neuroscience Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

12. Stroke Unit AORN Antonio Cardarelli Naples Italy

13. Department of Neurology Di Venere Hospital Bari Italy

14. Neurologia d’Urgenza‐Stroke Unit IRCCS Mondino Foundation Pavia Italy

15. Neurology Unit S.Maria delle Croci Hospital Ravenna Italy

16. Department of Neurology AOOR Villa Sofia‐Cervello Palermo Italy

17. Department of Medicine and Surgery University of Parma Italy

18. Neuroscienze, Organi di Senso e Torace Fondazione Policlinico Universitario Agostino Gemelli Rome Italy

19. Department of Neurology ASST‐Ovest Milanese Legnano Italy

20. Department of Internal and Cardiovascular Medicine Santa Maria della Misericordia Hospital Perugia Italy

21. IRCCS Istituto delle Scienze Neurologiche di Bologna Maggiore Hospital Bologna Italy

22. Stroke Unit “M. R. Dimiccoli” Hospital Barletta Italy

23. Medical Department E. Agnelli Hospital—Local Health Company (ASL) TO3 Pinerolo Italy

24. Stroke Unit S. Eugenio Hospital Rome Italy

25. Department of Neurology Cazzavillan Hospital Arzignano Italy

26. Emergency Department Azienda Ospedaliera Universitaria Senese Siena Italy

27. Department of Neurology Umberto I Hospital Siracusa Italy

28. Neurology Unit Ospedale “Madonna del Soccorso” San Benedetto del Tronto Italy

29. Experimental and Clinical Medicine Department Marche Polytechnic University Ancona Italy

30. Neurology Unit San Luca Hospital Lucca Castelnuovo Garfagnana Italy

31. Stroke Unit Policlinico Umberto I Hospital Rome Italy

32. Department of Neurology Fondazione IRCCS San Gerardo dei Tintori Monza Italy

33. Stroke Unit Azienda Ospedaliero‐Universitaria “Maggiore della Carità” Novara Italy

34. Stroke Unit Careggi University Hospital Florence Italy

35. Department of Neurology San Giacomo Hospital Novi Ligure Italy

36. Stroke Unit SS. Biagio e Arrigo Alessandria Italy

37. Department of Cardiocerebrovascular diseases ASST Ospedale Maggiore di Crema Crema Italy

38. Department of Neurology San Jacopo Hospital Pistoia Italy

39. Department of Neurology Antonio Perrino Hospital Brindisi Italy

40. Department of Neurology Sant’Andrea Hospital Rome Italy

41. Neurology Unit “Infermi” Hospital Rimini Italy

42. Stroke Unit “S.Spirito” Hospital Pescara Italy

43. Departiment of Neurology Istituto Ospedaliero Fondazione Poliambulanza Brescia Italy

44. Department of Neurology INRCA Ancona Italy

45. Department of Neurology SS Annunziata Hospital Chieti Italy

46. Dipartimento di Medicina e Scienze dell’Invecchiamento Università G. d’Annunzio di Chieti‐Pescara Pescara Italy

47. Department of Neurology Civil Hospital Cittadella Italy

48. Cardio‐Neuro‐Vascular Department, Neurology Unit Giovanni Paolo II Hospital Ragusa Italy

49. Department of Neurology St Misericordia Hospital Rovigo Italy

50. Department of Neurology Ospedale Civile Ss. Giovanni e Paolo Venezia Italy

51. Department of Neurology A. Murri Fermo Hospital Fermo Italy

52. Stroke Unit Azienda Ospedaliera San Camillo Rome Italy

53. Department of Neurology San Filippo Neri Hospital Rome Italy

54. Department of Neurology General Regional Hospital “F. Miulli” Acquaviva delle Fonti Italy

55. Internal Medicine San Giovanni di Dio Hospital Florence Italy

56. Department of Neuroscience San Bortolo Hospital Vicenza Italy

57. Stroke Unit AOU Sassari Sassari Italy

58. Neurology Unit Apuane Hospital Massa Italy

59. Department of Neurology Vito Fazi Hospital Lecce Italy

60. Department of Neurology Mirano Hospital Mirano Italy

61. Neuroscience IRCCS Ospedale Policlinico San Martino Genoa Italy

62. Department of Neurology Fatebenefratelli Hospital Rome Italy

63. Department of Neurology SS Annunziata Hospital Savigliano Italy

64. Department of Human neurosciences La Sapienza University Rome Italy

65. Coordinatore Comitato Scientifico ISA‐AII Citta’ di Castello Italy

66. Department of Brain Sciences Imperial College London London United Kingdom

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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3. Editorial Board

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