Brain and behavior
NIHSS and Large Artery Atherosclerosis Affect Efficacy of Dual Antiplatelet Therapy Versus Alteplase for Minor Stroke
By Cui Y, Li ZA, He C and 1 others.
Abstract
Background
Dual antiplatelet therapy (DAPT) was noninferior to alteplase in nondisabling minor stroke (NIHSS 0 to 5). Given potential benefit of DAPT in minor stroke with large artery atherosclerosis (LAA) and of alteplase in stroke with NIHSS 4-5, we hypothesize that neurological deficit and LAA may affect efficacy of DAPT versus alteplase in minor stroke.
Methods
This analysis included patients from the ARAMIS trial with minor stroke who underwent vessel imaging assessment. Participants were stratified into NIHSS 0-3 with LAA, NIHSS 0-3 with Non-LAA, NIHSS 4-5 with LAA, and NIHSS 4-5 with Non-LAA. Outcomes were compared between those receiving DAPT versus alteplase. Primary outcome was an excellent functional outcome (mRS 0 to 1) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and bleeding events. Primary analysis employed adjusted models, with sensitivity analysis conducted using inverse probability of treatment weighting.