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. 2025 Jul 12:18:17562864251351100.
doi: 10.1177/17562864251351100. eCollection 2025.

Real-world outcomes following dual antiplatelet therapy in mild-to-moderate ischemic stroke with anterior versus posterior circulation infarct: a READAPT study propensity matched analysis

Federico De Santis  1 , Raffaele Ornello  1 , Eleonora De Matteis  1   2   3 , Lucio D'Anna  2   3 , Michele Romoli  4 , Tiziana Tassinari  5 , Valentina Saia  5 , Silvia Cenciarelli  6 , Chiara Bedetti  6 , Chiara Padiglioni  6 , Bruno Censori  7 , Valentina Puglisi  7 , Luisa Vinciguerra  7 , Maria Guarino  8 , Valentina Barone  8 , Marialuisa Zedde  9 , Ilaria Grisendi  9 , Marina Diomedi  10 , Maria Rosaria Bagnato  10 , Marco Petruzzellis  11 , Domenico Maria Mezzapesa  11 , Vincenzo Inchingolo  12 , Manuel Cappellari  13 , Cecilia Zivelonghi  13 , Paolo Candelaresi  14 , Vincenzo Andreone  14 , Giuseppe Rinaldi  15 , Alessandra Bavaro  15 , Anna Cavallini  16 , Maria Grazia Piscaglia  17 , Valeria Terruso  18 , Marina Mannino  18 , Alessandro Pezzini  19   20 , Giovanni Frisullo  21 , Francesco Muscia  22 , Maurizio Paciaroni  23   24 , Maria Giulia Mosconi  23 , Andrea Zini  25 , Ruggiero Leone  26 , Carmela Palmieri  27 , Letizia Maria Cupini  28 , Michela Marcon  29 , Rossana Tassi  30 , Enzo Sanzaro  31 , Giuli Papiri  32 , Giovanna Viticchi  33 , Daniele Orsucci  34 , Anne Falcou  35 , Simone Beretta  36 , Roberto Tarletti  37 , Patrizia Nencini  38 , Eugenia Rota  39 , Federica Nicoletta Sepe  40 , Delfina Ferrandi  40 , Luigi Caputi  41 , Gino Volpi  42 , Salvatore La Spada  43 , Mario Beccia  44 , Claudia Rinaldi  45 , Vincenzo Mastrangelo  45 , Francesco Di Blasio  46 , Paolo Invernizzi  47 , Giuseppe Pelliccioni  48 , Maria Vittoria De Angelis  46   49 , Laura Bonanni  50 , Giampietro Ruzza  51 , Emanuele Alessandro Caggia  52 , Monia Russo  53 , Agnese Tonon  54 , Maria Cristina Acciarri  55 , Sabrina Anticoli  56 , Cinzia Roberti  57 , Gaspare Scaglione  58 , Francesca Pistoia  1 , Alberto Fortini  59 , Antonella De Boni  60 , Alessandra Sanna  61 , Alberto Chiti  62 , Leonardo Barbarini  63 , Marcella Caggiula  63 , Maela Masato  64 , Massimo Del Sette  65 , Francesco Passarelli  66 , Maria Roberta Bongioanni  67 , Manuela De Michele  68 , Stefano Ricci  6   69 , Simona Sacco  70 , Matteo Foschi  1
Affiliations

Real-world outcomes following dual antiplatelet therapy in mild-to-moderate ischemic stroke with anterior versus posterior circulation infarct: a READAPT study propensity matched analysis

Federico De Santis et al. Ther Adv Neurol Disord. .

Abstract

Background: Dual antiplatelet therapy (DAPT) is a cornerstone of secondary prevention in patients with minor ischemic stroke or high-risk transient ischemic attack. The effectiveness and safety of DAPT may differ between patients with posterior (PCI) and anterior circulation infarct (ACI).

Objectives: We aimed to compare short-term outcomes following DAPT between mild-to-moderate stroke patients with PCI versus ACI.

Design: Propensity-matched analysis from a prospective real-world multicentric cohort study (READAPT).

Methods: We included patients with noncardioembolic mild-to-moderate stroke (National Institute of Health Stroke Scale of 0-10) who initiated DAPT within 48 h of symptom onset. Patients were categorized into ACI or PCI based on the infarct(s) location on brain neuroimaging. The primary effectiveness outcome was the 90-day risk of ischemic stroke or other vascular events. The secondary effectiveness outcomes were the 90-day modified Rankin Scale (mRS) score distribution, 24-h early neurological improvement or deterioration, and all-cause mortality. The safety outcomes included the 90-day risk of any bleedings and 24-h hemorrhagic transformation.

Results: We matched 281 PCI patients with 651 ACI patients. The 90-day risk of ischemic stroke or other vascular events was low and similar between PCI and ACI groups (3.1% vs 2.9%, respectively; hazard ratio 0.98, (95% confidence interval (CI) 0.45-2.14); p = 0.845). Patients with PCI had worse 90-day mRS ordinal distribution compared to those with ACI (odds ratio 1.18 (95% CI 1.01-1.39); p = 0.046). There were no differences in other secondary outcomes. Safety outcomes had low incidence and did not differ between groups (any bleedings: 3.2% vs 2.6%; 24-h hemorrhagic transformation: 1.8% vs 1.2%). We found no differences in the risk of ischemic stroke or other vascular events between patients with PCI and ACI across subgroups defined by sex, age, presumed stroke etiology, stroke severity, prestroke mRS, hypertension, diabetes, acute reperfusion therapies, DAPT loading dose, or presence of symptomatic intracranial stenosis.

Conclusion: Our findings suggest that effectiveness and safety outcomes after DAPT in patients with mild-to-moderate noncardioembolic ischemic stroke are consistent regardless of infarct location in the anterior or posterior circulation territory. However, patients with PCI may experience worse short-term functional outcome.

Trial registration: URL: www.clinicaltrials.gov; Unique identifier: NCT05476081.

Keywords: dual antiplatelet therapy; effectiveness; infarct location; ischemic stroke; mild-to-moderate; outcomes; posterior circulation; safety.

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Conflict of interest statement

Dr M.G.Piscaglia reports grants from Sanofi Genzyme; grants from Roche Health Solutions Inc.; grants from Novartis Pharma; grants from Biogen; and grants from Merck Company Foundation. Dr M.Paciaroni reports compensation from Boehringer Ingelheim for other services; compensation from Pfizer Canada Inc. for other services; compensation from Bristol-Myers Squibb for other services; compensation from iRhythm Technologies for other services; compensation from Sanofi-Aventis U.S. LLC for other services; and compensation from Daiichi Sankyo Europe GmbH for other services. Dr A.Zini reports compensation from Bayer Healthcare for other services; compensation from Boehringer Ingelheim for consultant services; compensation from Alexion Pharmaceuticals for consultant services; and compensation from CSL Behring for consultant services. Dr R.Ornello reports grants from Novartis; compensation from Teva Pharmaceutical Industries for other services; compensation from AbbVie for data and safety monitoring services; compensation from Teva Pharmaceutical Industries for other services; compensation from Eli Lilly and Company for other services; compensation from Novartis for other services; compensation from H. Lundbeck A S for other services; compensation from Eli Lilly for data and safety monitoring services; grants from Pfizer; grants from Allergan; travel support from Teva Pharmaceutical Industries; and compensation from Teva Pharmaceutical Industries for consultant services. Dr S.Sacco reports compensation from Novartis for other services; compensation from Novo Nordisk for consultant services; compensation from Boehringer Ingelheim for consultant services; compensation from Teva Pharmaceutical Industries for consultant services; compensation from Allergan for consultant services; employment by Università degli Studi dell’Aquila; compensation from Novartis for consultant services; compensation from Allergan for consultant services; compensation from Pfizer Canada Inc. for consultant services; compensation from Abbott Canada for consultant services; compensation from H. Lundbeck A S for consultant services; compensation from AstraZeneca for consultant services; and compensation from Eli Lilly and Company for consultant services. The other authors report no conflicts.

Figures

Here is a JSON representation of the image:{"Content": "Study flow-chart.\r\nACI, anterior circulation infarct; DAPT, dual antiplatelet treatment; EA, endarterectomy; PCI, posterior circulation infarct; PSM, propensity-score matching."}
Figure 1.
Study flow-chart. ACI, anterior circulation infarct; DAPT, dual antiplatelet treatment; EA, endarterectomy; PCI, posterior circulation infarct; PSM, propensity-score matching.
Kaplan—Meier survival curves of 90-day first stroke events among the 1800 patients with 90-day stroke and risk of new ischemic stroke or other vascular events, stratified by anterior circulation infarct (ACI) and posterior circulation infarct (PCI). Dashed lines indicate 95% confidence intervals.
Figure 2.
Kaplan–Meier hazard function of 90-day new ischemic stroke or other vascular events. Dashed lines indicate 95% confidence intervals. ACI, anterior circulation infarct; PCI, posterior circulation infarct.
""PCTI 9 and CI "100". 1 (6). ACI 3 in 30 (CI 11. 5. "PCTI 7, CI 12.1".
Figure 3.
90-Day modified Rankin Scale scores distribution. ACI, anterior circulation infarct; CI, confidence interval; mRS, modified Rankin Scale score; OR, odds ratio (PCI vs ACI); PCI, posterior circulation infarct.
See this image and copyright information in PMC

References

    1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation 2023; 147(8): e93–e621. - PMC - PubMed
    1. Markus HS, van der Worp HB, Rothwell PM. Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol 2013; 12: 989–998. - PubMed
    1. Merwick A, Werring D. Posterior circulation ischaemic stroke. BMJ 2014; 348: g3175. - PubMed
    1. Caplan LR, Wityk RJ, Glass TA, et al. New England medical center posterior circulation registry. Ann Neurol 2004; 56: 389–398. - PubMed
    1. Kim JS, Nah HW, Park SM, et al. Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anterior compared with posterior circulation disease. Stroke 2012; 43: 3313–3318. - PubMed

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