Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h

Background/Purpose: In patients with noncardioembolic acute minor ischemic stroke (AMIS), dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel within 24 h after stroke onset was more effective than aspirin alone. This study investigated the efficacy and safety of DAPT in AMIS patients with...

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Main Authors: Po-Lin Chen, Yu-Hsuan Wu, Jin-An Huang, Nien-Chen Liao, Yi-Ting Chao, Chi-Sheng Wang
Format: Article
Language:English
Published: Elsevier 2024-04-01
Series:Journal of the Formosan Medical Association
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S0929664623003960
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author Po-Lin Chen
Yu-Hsuan Wu
Jin-An Huang
Nien-Chen Liao
Yi-Ting Chao
Chi-Sheng Wang
author_facet Po-Lin Chen
Yu-Hsuan Wu
Jin-An Huang
Nien-Chen Liao
Yi-Ting Chao
Chi-Sheng Wang
author_sort Po-Lin Chen
collection DOAJ
description Background/Purpose: In patients with noncardioembolic acute minor ischemic stroke (AMIS), dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel within 24 h after stroke onset was more effective than aspirin alone. This study investigated the efficacy and safety of DAPT in AMIS patients with an onset-to-door time (OTDT) of more than 24 h. Methods: This was a retrospective analysis of a prospective stroke registry from 2015 to 2021. Patients with AMIS and an OTDT within seven days were classified into the Early (≤24 h) and Late groups (>24 h) according to the time of antiplatelet administration after stroke onset. Results: In total, 691 patients were identified. Of these, 446 (64.5%) and 245 (35.5%) patients were classified into the Early and Late groups, respectively. The rates of recurrent infarction and symptomatic intracranial hemorrhage at 90 days were similar between the single antiplatelet therapy (SAPT) and DAPT subgroups in both the Early and Late groups. More patients in the DAPT subgroup had a favorable outcome (modified Rankin scale of 0–1) at 90 days in both Early (84.2% versus 75.0%, p = 0.016) and Late (88.2% versus 76.9%, p = 0.040) groups. DAPT was independently associated with a favorable outcome in both the Early (odds ratio, 1.95; 95% CI, 1.15–3.32; p = 0.013) and Late (odds ratio, 2.72; 95% CI, 1.14–6.48; p = 0.024) groups. Conclusion: In patients with AMIS and an OTDT of more than 24 h, DAPT was associated with a favorable outcome at 90 days.
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spelling doaj.art-1ddf5335689b406c9e246d45612a6e3f2024-04-10T04:28:32ZengElsevierJournal of the Formosan Medical Association0929-66462024-04-011234501509Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 hPo-Lin Chen0Yu-Hsuan Wu1Jin-An Huang2Nien-Chen Liao3Yi-Ting Chao4Chi-Sheng Wang5Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, TaiwanDivision of Neurology, Neurological Institute, Taichung Veterans General Hospital, TaiwanDivision of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Health Business Administration, Hungkuang University, Taichung, TaiwanDivision of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taiwan; Center of Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taiwan; Corresponding author. Neurological Institute of Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan.Background/Purpose: In patients with noncardioembolic acute minor ischemic stroke (AMIS), dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel within 24 h after stroke onset was more effective than aspirin alone. This study investigated the efficacy and safety of DAPT in AMIS patients with an onset-to-door time (OTDT) of more than 24 h. Methods: This was a retrospective analysis of a prospective stroke registry from 2015 to 2021. Patients with AMIS and an OTDT within seven days were classified into the Early (≤24 h) and Late groups (>24 h) according to the time of antiplatelet administration after stroke onset. Results: In total, 691 patients were identified. Of these, 446 (64.5%) and 245 (35.5%) patients were classified into the Early and Late groups, respectively. The rates of recurrent infarction and symptomatic intracranial hemorrhage at 90 days were similar between the single antiplatelet therapy (SAPT) and DAPT subgroups in both the Early and Late groups. More patients in the DAPT subgroup had a favorable outcome (modified Rankin scale of 0–1) at 90 days in both Early (84.2% versus 75.0%, p = 0.016) and Late (88.2% versus 76.9%, p = 0.040) groups. DAPT was independently associated with a favorable outcome in both the Early (odds ratio, 1.95; 95% CI, 1.15–3.32; p = 0.013) and Late (odds ratio, 2.72; 95% CI, 1.14–6.48; p = 0.024) groups. Conclusion: In patients with AMIS and an OTDT of more than 24 h, DAPT was associated with a favorable outcome at 90 days.http://www.sciencedirect.com/science/article/pii/S0929664623003960Acute minor ischemic strokeDual antiplatelet therapyOnset-to-door timeOutcome
spellingShingle Po-Lin Chen
Yu-Hsuan Wu
Jin-An Huang
Nien-Chen Liao
Yi-Ting Chao
Chi-Sheng Wang
Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
Journal of the Formosan Medical Association
Acute minor ischemic stroke
Dual antiplatelet therapy
Onset-to-door time
Outcome
title Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
title_full Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
title_fullStr Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
title_full_unstemmed Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
title_short Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h
title_sort dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset to door time beyond 24 h
topic Acute minor ischemic stroke
Dual antiplatelet therapy
Onset-to-door time
Outcome
url http://www.sciencedirect.com/science/article/pii/S0929664623003960
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