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. 2025 Apr 30:16:1568711.
doi: 10.3389/fneur.2025.1568711. eCollection 2025.

Renal function and efficacy of dual antiplatelet vs. alteplase in minor stroke: a post hoc analysis of ARAMIS study

Xiao-Yi He #  1   2   3 , Chao He #  2 , Hui-Sheng Chen  1   2
Affiliations

Renal function and efficacy of dual antiplatelet vs. alteplase in minor stroke: a post hoc analysis of ARAMIS study

Xiao-Yi He et al. Front Neurol. .

Abstract

Background: This secondary analysis of the ARAMIS trial evaluated renal function's modifying effects on therapeutic responses to dual antiplatelet therapy (DAPT) versus intravenous thrombolysis in acute minor ischemic stroke.

Methods: Based on the as-treated set, we stratified patients by admission estimated glomerular filtration rate into three groups: normal renal function (≥90 mL/min/1.73 m2), mildly decreased renal function (eGFR 60 to 89 mL/min/1.73 m2), and moderate to severe impairment renal function group (<60 mL/min/1.73 m2). The primary endpoint was excellent functional outcome defined as a modified Rankin Scale score of 0-1 at 90 days.

Results: Among 615 analyzed patients, 367 (59.7%) exhibited normal renal function, 209 (34.0%) exhibited mildly decreased renal function and 39 (6.3%) exhibited moderate to severe impairment renal function. A numerically higher rate of excellent functional outcome was found in normal renal function patients with DAPT vs. alteplase (94.4% vs. 90.4%; p = 0.147), while no intergroup difference emerged in mildly decreased renal function patients (93.9% vs. 93.7%; p = 0.958) and moderate to severe impairment renal function patients (93.8% vs. 95.7%; p = 0.792). There was no significant interaction between treatment and renal function on the primary outcome (adjusted interaction p = 0.337).

Conclusion: Among patients with normal renal function, DAPT was associated with a numerically higher, but not statistically significant, rate of excellent functional outcome in patients with minor nondisabling acute ischemic stroke presenting within 4.5 h of symptom onset compared with alteplase.

Clinical trial registration: ClinicalTrials.gov, identifier NCT03661411.

Keywords: clinical outcome; dual antiplatelet; intravenous thrombolysis; minor stroke; renal function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of the study.
Figure 2
Figure 2
Distribution of modified Rankin Scale (mRS) score between three groups according to renal function status.
Figure 3
Figure 3
The relationship between the probability of modified Rankin Scale (mRS) score 0 to1 and estimated glomerular filtration rate (eGFR).
See this image and copyright information in PMC

References

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