2024 American Academy of Neurology Abstract Website

Objective:

To investigate the safety and efficacy of dual antiplatelet therapy (DAPT) within 90 days after intravenous thrombolysis (IVT) in patients with minor stroke or high risk transient ischemic attack (TIA).

Background:

Minor stroke is defined by a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less. Prior trials have shown efficacy of short term DAPT in secondary prevention of stroke among patients with TIA or minor ischemic stroke and noninferiority of DAPT compared to IVT among patients with minor non disabling stroke. No randomized trials were made regarding this subject.

Design/Methods:

We reviewed the medical records of patients aged 18 years or older who received thrombolytic treatment between 2015 and 2022, diagnosed with acute minor stroke or high-risk TIA (negative diffusion-weighted imaging on follow-up). Exclusion criteria were NIHSS>5, cardioembolic stroke, stroke mimics, intracranial bleeding after thrombolysis and absence of complete follow-up (90 days).

Antiplatelet therapy was initiated 24 hours after thrombolysis based on the physician's judgment and maintained for 21 to 180 days. Patients were divided in two groups: single and dual antiplatelet therapy. We assessed the modified Rankin scale -mRS-, symptomatic intracranial hemorrhage (SICH) and mortality at 90 days.

Results:

Fifty-three patients were enrolled, 68% were men aged 64 ±16,5 years. There were no differences in baseline characteristics. Seventy-five percent had ischemic stroke. Forty-nine percent were in the single antiplatelet group, and fifty-one percent were in the dual antiplatelet group.

There was no difference in the 90-day mRS. No patients experienced SICH or mortality during the follow-up. One patient in the single antiplatelet group had a stroke recurrence.

Conclusions:

DAPT after IVT with rt-PA for acute minor stroke and high risk TIA appears not to increase the risk of bleeding and mortality compared to single antiplatelet therapy.