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

Disclosures

Stroke. 2019;50(4):1007-1009. 

In This Article

Discussion

We demonstrated a relevant improvement of functional outcome after DAPT without increased risk for symptomatic hemorrhage in progressive lacunar strokes which occurred in 28% of patients with lacunar strokes in our study. DAPT was associated with relevant clinical improvements after END (primary end point: 68% versus 36% with standard treatment; P=0.0019) and reduction of clinical fluctuation (79% versus 33%; P<0.001). Similar results of DAPT efficacy were obtained in the subgroup of patients presenting with END after treatment with systemic thrombolysis.

These data are further sustained by the subgroup analysis of the POINT trial demonstrating particular efficacy of DAPT during the first 7 days after ischemic event,[3] which represents exactly the time for END occurrence, but was not distinguished from stroke recurrence in this trial.[4] Additionally, the POINT trial revealed a significant increase of major hemorrhage after 7 days of DAPT, supporting the shorter treatment duration of 5 days used in our clinical routine.

Results of this study are limited by the retrospective nature of analysis, small number of patients with DAPT after thrombolysis, and the absence of randomization for different treatments inducing potential selection bias. Reasons for individual treatment decisions were retrospectively not determinable. Furthermore, efficacy end points consisting in comparison of NIHSS or Rankin Scale scores between discharge and admission might underestimate DAPT efficacy but aimed to analyze clinically relevant, reliable, and sustained DAPT efficacy. Therefore, a randomized clinical trial is necessary to validate DAPT efficacy in progressive lacunar strokes which were not explicitly analyzed in the POINT trial.

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