Ashayeri Ahmadabad Rezan, Almekhlafi Mohammed, Sylaja P N, Deshmukh Aviraj, Dawson Jesse, Pikula Aleksandra, Hussain Muhammad Shazam, Zhang Yiran, Asdaghi Negar, Sohn Sung-Ii, Wasay Mohammad, Shuaib Ashfaq, Buck Brian, Kate Mahesh Pundlik
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada,
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Cerebrovasc Dis Extra. 2025;15(1):162-172. doi: 10.1159/000546654. Epub 2025 May 30.
Patients who have undergone reperfusion treatments, like all ischemic stroke patients, are at risk of recurrent ischemic strokes in the first 90 days. Current guidelines recommend single antiplatelet therapy for secondary prevention at variable time points after the procedure. This study assessed the practices and perspectives of healthcare professionals on the use of dual antiplatelet therapy in patients with non-cardioembolic ischemic stroke who have undergone reperfusion therapy.
We conducted a multinational cross-sectional web-based survey using Qualtrics involving neurologists and non-neurologist stroke physicians (including neurosurgeons, interventional neuroradiologists, and internal medicine physicians). Participants were asked about their current practices and presented with six structured case scenarios to determine their treatment preferences. In the case scenarios, we assessed their willingness to randomize to a clinical trial comparing single versus dual antiplatelets. Multinomial logistic regression analysis was performed to assess the relationship between demographic characteristics and willingness to randomize.
A total of 278 clinicians from 26 countries participated in the survey. The most common continent of practice was Asia (155/278; 55.9%). The most common area of practice was neurology (220/278; 79.1%), with most participants having 5-15 years of experience (115/278; 41.5%) and working in comprehensive stroke centers (205/278; 73.9%). Antiplatelet Choice: For a small infarct post-intravenous thrombolysis and endovascular thrombectomy (EVT), 194/278 (69.8%) preferred aspirin, and 49/278 (17.6%) chose a dual antiplatelet strategy with aspirin and clopidogrel. Loading of Antiplatelet: A total of 121/278 (43.5%) indicated they would not administer a loading dose in cases even with small final infarctions. Timing of Antiplatelet Initiation: Preferences varied; 61/278 (21.7%) considered early initiation immediately post-EVT, and 103/278 (37.2%) considered 24 h post-EVT. Willingness to Randomize: A total of 16/278 (77.7%) were willing or would consider randomizing in a clinical trial with dual antiplatelet. On regression analyses, the willingness to randomize was influenced by years of practice and the local volume of reperfusion therapy.
Antiplatelet management for secondary stroke prevention in patients with non-cardioembolic ischemic stroke following reperfusion therapy is variable. However, more than three-fourths of participants were willing to consider randomization to a clinical trial exploring the prevention of recurrent stroke after reperfusion therapy.
接受再灌注治疗的患者，与所有缺血性中风患者一样，在最初90天内有复发性缺血性中风的风险。当前指南建议在手术后不同时间点采用单一抗血小板治疗进行二级预防。本研究评估了医疗保健专业人员对接受再灌注治疗的非心源性缺血性中风患者使用双重抗血小板治疗的实践和观点。
我们使用Qualtrics进行了一项基于网络的跨国横断面调查，涉及神经科医生和非神经科中风医生（包括神经外科医生、介入神经放射科医生和内科医生）。参与者被问及他们当前的实践情况，并呈现六个结构化病例场景以确定他们的治疗偏好。在病例场景中，我们评估了他们将患者随机分配到比较单一抗血小板与双重抗血小板治疗的临床试验的意愿。进行多项逻辑回归分析以评估人口统计学特征与随机分配意愿之间的关系。
来自26个国家的278名临床医生参与了调查。最常见的执业地区是亚洲（155/278；55.9%）。最常见的执业领域是神经科（220/278；79.1%），大多数参与者有5 - 15年的经验（115/278；41.5%）且在综合中风中心工作（205/278；73.9%）。抗血小板药物选择：对于静脉溶栓和血管内血栓切除术（EVT）后出现小梗死灶的患者，194/278（69.8%）倾向于使用阿司匹林，49/278（17.6%）选择阿司匹林和氯吡格雷的双重抗血小板策略。抗血小板药物的负荷剂量：共有121/278（43.5%）表示，即使最终梗死灶较小，他们在某些情况下也不会给予负荷剂量。抗血小板药物起始时间：偏好各不相同；61/278（21.7%）认为在EVT后立即早期起始用药，103/278（37.2%）认为在EVT后24小时起始用药。随机分配意愿：共有16/278（77.7%）愿意或会考虑在双重抗血小板治疗的临床试验中进行随机分配。在回归分析中，随机分配意愿受执业年限和当地再灌注治疗量的影响。
非心源性缺血性中风患者再灌注治疗后二级预防的抗血小板管理存在差异。然而，超过四分之三的参与者愿意考虑随机分配到一项探索再灌注治疗后预防复发性中风的临床试验中。
