A REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack (READAPT)
Author:
De Matteis EleonoraORCID, Ornello RaffaeleORCID, De Santis Federico, Foschi MatteoORCID, Romoli MicheleORCID, Tassinari TizianaORCID, Saia Valentina, Cenciarelli SilviaORCID, Bedetti Chiara, Padiglioni Chiara, Censori BrunoORCID, Puglisi ValentinaORCID, Vinciguerra LuisaORCID, Guarino MariaORCID, Barone ValentinaORCID, Zedde MarialuisaORCID, Grisendi IlariaORCID, Diomedi MarinaORCID, Bagnato Maria RosariaORCID, Petruzzellis MarcoORCID, Mezzapesa Domenico MariaORCID, Di Viesti Pietro, Inchingolo Vincenzo, Cappellari Manuel, Zenorini Mara, Candelaresi PaoloORCID, Andreone Vincenzo, Rinaldi Giuseppe, Bavaro AlessandraORCID, Cavallini AnnaORCID, Morau Stefan, Querzani Pietro, Terruso Valeria, Mannino MarinaORCID, Pezzini AlessandroORCID, Frisullo GiovanniORCID, Muscia FrancescoORCID, Paciaroni MaurizioORCID, Mosconi Maria GiuliaORCID, Zini AndreaORCID, Leone RuggieroORCID, Palmieri Carmela, Cupini Letizia MariaORCID, Marcon Michela, Tassi RossanaORCID, Sanzaro EnzoORCID, Paci CristinaORCID, Viticchi GiovannaORCID, Orsucci Daniele, Falcou AnneORCID, Diamanti Susanna, Tarletti Roberto, Nencini PatriziaORCID, Rota EugeniaORCID, Sepe Federica Nicoletta, Ferrandi Delfina, Caputi Luigi, Volpi Gino, Spada Salvatore La, Beccia Mario, Rinaldi Claudia, Mastrangelo Vincenzo, Blasio Francesco Di, Invernizzi PaoloORCID, Pelliccioni Giuseppe, De Angelis Maria Vittoria, Bonanni LauraORCID, Ruzza GiampietroORCID, Caggia Emanuele Alessandro, Russo Monia, Tonon AgneseORCID, Acciarri Maria Cristina, Anticoli SabrinaORCID, Roberti Cinzia, Manobianca Giovanni, Scaglione Gaspare, Pistoia FrancescaORCID, Fortini Alberto, De Boni Antonella, Sanna Alessandra, Chiti Alberto, Barbarini Leonardo, Caggiula Marcella, Masato Maela, Del Sette Massimo, Passarelli Francesco, Bongioanni Maria Roberta, Toni DaniloORCID, Ricci StefanoORCID, Sacco SimonaORCID,
Abstract
AbstractBackground and purposeClinical 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.MethodsREADAPT (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.ResultsWe 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.ConclusionsShort-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.
Publisher
Cold Spring Harbor Laboratory
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