Minor Stroke Treatment: Dual Antiplatelet Therapy vs. Intravenous Thrombolysis

When a minor stroke strikes, swift and suitable treatment is vital. A clinical trial from China tackled the effectiveness of two treatments for minor strokes: Dual Antiplatelet Therapy (DAPT) and Intravenous Thrombolysis. This research aimed to determine which treatment worked better for minor, non-disabling strokes.

Clinical trial

Minor strokes, although less severe, demand immediate attention. This trial involved 760 patients experiencing minor, non-disabling strokes. These strokes cause mild impairment, measured by a National Institutes of Health Stroke Scale score of 5 or lower.

This trial was carried out across 38 hospitals in China. It sought to compare the outcomes of DAPT and Intravenous Thrombolysis. Patients were randomly assigned to receive either DAPT or Intravenous Thrombolysis within 4.5 hours of experiencing symptoms.

• Dual Antiplatelet Therapy: Patients in this group received a combination of clopidogrel and aspirin for 12 days, followed by guideline-based antiplatelet treatment until 90 days.

• Intravenous Thrombolysis: Patients in this group received intravenous alteplase followed by guideline-based antiplatelet treatment after 24 hours.

Results

The primary goal was to determine the excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 or 1. The trial revealed the following:

• DAPT vs. Alteplase: At the 90-day mark, 93.8% of patients in the DAPT group and 91.4% in the Alteplase group showed excellent functional outcomes.

• Noninferiority Confirmed: The difference between the two treatments fell within the predetermined noninferiority margin. This indicates that DAPT is as effective as Intravenous Thrombolysis in achieving excellent functional outcomes for minor, non-disabling strokes.

• Safety Measures: The trial also considered safety concerns, such as symptomatic intracerebral hemorrhage. Both treatments had a low incidence of this adverse event.

Implications

This trial suggests that for individuals experiencing minor, non-disabling strokes, DAPT can be as effective as Intravenous Thrombolysis in achieving excellent functional outcomes at the 90-day mark. Both treatments also showed promising safety profiles.

These findings offer valuable guidance to healthcare professionals when treating minor strokes. With DAPT showing noninferiority to Intravenous Thrombolysis, patients may have an alternative treatment option with comparable outcomes. This research could influence treatment decisions, ensuring personalized care for each patient based on their condition and preferences.

Conclusion

This trial's outcomes hold significant implications for managing minor strokes. While Intravenous Thrombolysis has been a standard treatment, evidence supporting the effectiveness of Dual Antiplatelet Therapy provides an encouraging alternative. However, individual patient factors and preferences remain crucial in choosing the most suitable treatment approach.

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