Dual Antiplatelet Therapy Improves Functional Outcome in Patients With Progressive Lacunar Strokes

Anne Berberich, MD; Christine Schneider, MD; Tilman Reiff, MD; Christoph Gumbinger, MD; Peter Arthur Ringleb, MD


Stroke. 2019;50(4):1007-1009. 

In This Article


Four hundred fifty-eight patients with lacunar strokes were included in this study. Two hundred fifty-two patients received CT and MRI diagnostics as neuroimaging, 150 patients only received CT, and 56 patients received only MRI.

END occurred in 130 (28%) of the 458 patients with lacunar strokes. Eighty-five patients with END received CT and MRI for neuroimaging, 26 patients received only CT, and 85 patients received only MRI. First neuroimaging was performed after a median of 4.26 hours (interquartile range, 8.65) and MRI after a median of 19.6 hours (interquartile range, 31) after clinical onset. Sixty-six (14%) of all patients and 32 (25%) of patients with END were treated with systemic thrombolysis at admission. END occurred in 32 (48%) of the 66 patients treated with thrombolysis. The frequency of single antiplatelet therapy before admission was similar in patients with and without END (32% versus 26%). END mainly consisted in deterioration of motor paresis, ataxic paresis, or senso-motoric paresis (in 45, 25, and 55 patients, respectively). Clinical characteristics and outcomes of patients are presented in Table 1 and in Table I in the online-only Data Supplement.

DAPT was initiated after occurrence of END in 97 (75%) of the 130 patients with progressive lacunar strokes. DAPT was mostly begun at the day of admission or 1 day after (33% or 43%) and within 4 days in all patients and mainly continued for 5 days (87%). DAPT was significantly associated with an improved functional outcome: primary end point was met in 68% (66) of all patients treated with DAPT compared with 36% (12) of patients without DAPT (P=0.0019; Table 2). Secondary end point with absence of further clinical fluctuation was achieved in 79% (77) of patients with DAPT compared with 33% (11) of patients without DAPT (P<0.001; Table 2). The end point of improvement of Rankin Scale score after END was not fulfilled because no statistical significance was reached. Symptomatic bleeding complications were not observed in any patient treated with DAPT, regardless of prior thrombolysis or not.

In the subgroup of patients treated with systemic thrombolysis at admission, END occurred in 32 (48%) of the 66 patients and DAPT was initiated in 17 (53%) of these patients. Although DAPT did not reach statistical significance in fulfilling the primary end point or secondary end point of reducing further clinical fluctuations, the results indicated favorable effects of DAPT. Moreover, DAPT resulted in improvement of Rankin Scale score in 94% (16) versus 60% (9) of patients (P=0.03; Table 2). Systemic thrombolysis did not influence DAPT efficacy regarding efficacy end points once END occurred (Table II in the online-only Data Supplement).