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.

Conclusions

In conclusion, based on our study of 130 patients with END, 5 days of DAPT within 4 days of onset of lacunar infarction was associated with improved functional outcomes and no observed increased risk of symptomatic intracerebral bleeding. The apparent overall benefit from DAPT in patients with lacunar stroke and END needs testing in randomized trials.

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Table 1. Clinical Characteristics of Patients With and Without END Subdivided in Patients With and Without Thrombolysis at Admission
Clinical Characteristics	Patients Without END (n=238)		Patients With END (n=130)
Clinical Characteristics	With Thrombolysis (n=34)	Without Thrombolysis (n=294)	With Thrombolysis (n=32)	Without Thrombolysis (n=98)
Age, median; (range)	74 (38–90)	69.7 (37–89)	69.3 (42–91)	70 (42–89)
Female gender, n	13	108	4	29
Hypertension, n	32	275	24	90
Diabetes mellitus, n	16	84	6	26
HbA1c, median (IQR)	6.1 (1.6)	5.7 (1.3)	5.7 (0.5)	5.8 (1)
Hypercholesterolemia, n	22	188	19	73
LDL-cholesterol, median (IQR)	112 (63)	120 (49)	124.5 (39)	127 (49)
Smoker, n	9	103	13	30
Prior TIA, n	…	7	…	…
Lacunar syndrome, n
Motor paresis without sensory symptoms	9	70	12	33
Ataxic paresis	3	64	2	23
Senso-motor paresis	14	58	17	38
Sensory symptoms without paresis	2	35	…	2

Hypertension, diabetes mellitus, or hypercholesterolemia was defined as diagnosis made before admission or systolic blood pressure ≥140 mm Hg, HbA1c ≥6.5, or LDL-cholesterol ≥120 mg/dL. For lacunar syndromes, only symptoms regarding paresis and sensory symptoms were revised. Most patients had additional facial paresis or dysarthria. END indicates early neurological deterioration; HbA1c, hemoglobin A1c; IQR, interquartile range; LDL, low-density lipoprotein; and TIA, transient ischemic attack.

Table 2. Efficacy of DAPT in All Patients With Progressive Lacunar Strokes and Subdivided in Patients With and Without Thrombolysis
End Points	All Patients (n=130)			Patients With Thrombolysis (n=32)			Patients Without Thrombolysis (n=98)
End Points	DAPT (n=97)	No DAPT (n=33)	P Value	DAPT (n=17)	No DAPT (n=15)	P Value	DAPT (n=80)	No DAPT (n=18)	P Value
Fulfilled primary end point	66 (68%)	12 (36%)	0.0019	14 (82%)	8 (53%)	0.13	52 (65%)	4 (22%)	0.0013
Fulfilled secondary end points
Rankin Scale score	78 (80%)	24 (73%)	0.46	16 (94%)	9 (60%)	0.03	62 (78%)	15 (83%)	0.76
No further fluctuation	77 (79%)	11 (33%)	<0.001	15 (88%)	9 (60%)	0.1	62 (78%)	2 (11%)	<0.001
No bleeding complications	97	33	…	17	15	…	80	18	…

For efficacy end points, NIHSS and Rankin Scale scores were compared between discharge and admission. P values of DAPT efficacy were calculated with Fisher exact test. DAPT indicates dual anti-platelet therapy; and NIHSS, National Institutes of Health Stroke Scale.