Department of Neurology, Henan Key Laboratory of Cerebrovascular Disease, the First Affiliated Hospital of Zhengzhou University At Zhengzhou, 1st Jianshe Eastern Road, Zhengzhou, 450052, Henan, China.
Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Sci Rep. 2020 Nov 5;10(1):19132. doi: 10.1038/s41598-020-75666-6.
Dual antiplatelet therapy (DAPT) reduced stroke risk in high-risk transient ischemic attack (TIA) patients assessed by ABCD2 score. Patients with positive diffusion-weighted imaging (DWI) were identified as imaging-based high-risk. The present study aims to investigate whether DAPT could reduce stroke risk in TIA with DWI positive. The study enrolled TIA patients within 72 h of onset from the prospective TIA database of the First Affiliated Hospital of Zhengzhou University. The predictive outcome was ischemic stroke at 90-day. The relationship between DAPT and stroke was analyzed in a cox proportional hazards model. The Kaplan-Meier curves of TIA patients with DAPT and monotherapy were plotted. Total of 661 TIA patients were enrolled, 279 of whom were DWI positive and 281 used DAPT. The 90-day stroke risk was higher in patients used monotherapy than those used DAPT in TIA with positive DWI (23.7% vs. 13.4%, p = 0.029). DAPT was associated with reduced stroke risk in TIA patients with positive DWI (hazard ratio [HR] = 0.54; 95% confidence interval [CI], 0.30-0.97; p = 0.037). However, the benefit didn't exist in TIA patients with negative DWI (HR = 0.43; 95% CI, 0.14-1.33; p = 0.142). Early use of DAPT reduced stroke risk in TIA patients with positive DWI.
双联抗血小板治疗（DAPT）降低了 ABCD2 评分评估的高危短暂性脑缺血发作（TIA）患者的卒中风险。有阳性弥散加权成像（DWI）的患者被认为是影像学上的高危患者。本研究旨在探讨 DAPT 是否能降低 DWI 阳性的 TIA 患者的卒中风险。该研究纳入了郑州大学第一附属医院前瞻性 TIA 数据库中发病 72 小时内的 TIA 患者。预测结果为 90 天内的缺血性卒中。采用 Cox 比例风险模型分析 DAPT 与卒中的关系。绘制了接受 DAPT 和单药治疗的 TIA 患者的 Kaplan-Meier 曲线。共纳入 661 例 TIA 患者，其中 279 例为 DWI 阳性，281 例接受 DAPT。在 DWI 阳性的 TIA 患者中，与单药治疗相比，DAPT 治疗患者的 90 天卒中风险更高（23.7%比 13.4%，p=0.029）。DAPT 与 DWI 阳性的 TIA 患者的卒中风险降低相关（风险比[HR]为 0.54；95%置信区间[CI]为 0.30-0.97；p=0.037）。然而，在 DWI 阴性的 TIA 患者中，这种获益并不存在（HR 为 0.43；95%CI 为 0.14-1.33；p=0.142）。早期使用 DAPT 降低了 DWI 阳性的 TIA 患者的卒中风险。
