Dual antiplatelet therapy in acute ischaemic stroke with or without cerebral microbleeds. (23rd February 2023)

• Record Type: Journal Article
• Authors: Wang, Meng; Yang, Yuyuan; Wang, Yajuan; Luan, Moxin; Xu, Lulu; Zhong, Meixiang; Zheng, Xueping
• Is Part Of: European journal of neuroscience. Volume 57:Number 7(2023)
• Page Start: 1197
• Page End: 1207
• Publication Date: 2023-02-23
• Subjects: antiplatelet therapy -- cerebral microbleeds -- intracerebral haemorrhage -- ischaemic stroke -- prognosis; Nervous system -- Periodicals; 612.8
• DOI: 10.1111/ejn.15938
• Languages: English
• ISSNs: 0953-816X

Abstract

Abstract: Antiplatelet therapy (APT) plays an important role in the prevention of ischaemic stroke (IS). Our aim was to assess the influence of short‐term single APT (SAPT) and dual APT (DAPT) on the prognosis of patients with acute IS with and without cerebral microbleeds (CMBs). We conducted a single‐centre, retrospective, observational cohort study of patients with acute IS who underwent susceptibility‐weighted imaging (SWI) to determine the presence of CMBs between January 2015 and December 2020. The patients were treated with either DAPT or SAPT and followed up for at least 2 years. The primary endpoint was a composite of recurrent IS and intracerebral haemorrhage (ICH), while either recurrent IS or ICH was considered as other endpoints. We computed weighted Kaplan–Meier curves and identified risk factors using the Cox proportional hazards model. Among the 581 enrolled patients, those with CMBs ( n = 225; P = 0.004) had a higher risk of the primary endpoint than those without CMBs ( n = 356), especially higher risk of recurrent IS ( P = 0.029). In the SAPT group, the presence of CMBs increased the risk of the primary endpoint ( P = 0.013), especially that of recurrent IS ( P = 0.019). In the DAPT group, the occurrence of ICH was higher in patients with CMBs ( P = 0.031). The CMB distribution did not influence the risk of recurrent IS or ICH. In patients with acute IS and CMBs, DAPT may offset the risk of recurrent IS due to CMBs but increase the risk of ICH. Abstract : Our study evaluates the influence of short‐term single (SAPT) and dual antiplatelet therapy (DAPT) on the prognosis of patients with acute ischaemic stroke (IS) and cerebral microbleeds (CMBs). Our findings show that in patients with acute IS and CMBs, DAPT may offset the risk of recurrent IS due to CMBs. We also found that DAPT may increase the risk of ICH. Further studies are needed to clarify the relationship of CMBs, APT and the post‐IS risk of stroke.