Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke

被引：17

作者：

De Matteis, Eleonora ^{[1
]}

De Santis, Federico ^{[1
]}

Ornello, Raffaele ^{[1
]}

Censori, Bruno ^{[2
]}

Puglisi, Valentina ^{[2
]}

Vinciguerra, Luisa ^{[2
]}

Giossi, Alessia ^{[2
]}

Di Viesti, Pietro ^{[3
]}

Inchingolo, Vincenzo ^{[3
]}

Fratta, Giovanni Matteo ^{[3
]}

Diomedi, Marina ^{[4
]}

Bagnato, Maria Rosaria ^{[4
]}

Cenciarelli, Silvia ^{[5
]}

Bedetti, Chiara ^{[5
]}

Padiglioni, Chiara ^{[5
]}

Tassinari, Tiziana ^{[6
]}

Saia, Valentina ^{[6
]}

Russo, Alessandro ^{[6
]}

Petruzzellis, Marco ^{[7
,8
]}

Mezzapesa, Domenico Maria ^{[7
,8
]}

Caccamo, Martina ^{[7
,8
]}

Rinaldi, Giuseppe ^{[9
]}

Bavaro, Alessandra ^{[9
]}

Paciaroni, Maurizio ^{[10
]}

Mosconi, Maria Giulia ^{[10
]}

Foschi, Matteo ^{[1
,11
]}

Querzani, Pietro ^{[11
]}

Muscia, Francesco ^{[12
]}

Gallo Cassarino, Serena ^{[12
]}

Candelaresi, Paolo ^{[13
,14
]}

De Mase, Antonio ^{[13
,14
]}

Guarino, Maria ^{[15
]}

Cupini, Letizia Maria ^{[16
,17
]}

Sanzaro, Enzo ^{[18
,19
]}

Zini, Andrea ^{[20
,21
]}

La Spada, Salvatore ^{[22
]}

Palmieri, Carmela ^{[23
]}

Sepe, Federica Nicoletta ^{[24
,25
]}

Beretta, Simone ^{[26
]}

Paci, Cristina ^{[27
]}

Caggia, Emanuele Alessandro ^{[28
]}

De Angelis, Maria Vittoria ^{[29
,30
]}

Bonanni, Laura ^{[31
,32
,33
]}

Volpi, Gino ^{[34
]}

Tassi, Rossana ^{[35
]}

Pistoia, Francesca ^{[1
]}

Scoditti, Umberto ^{[36
]}

Tonon, Agnese ^{[37
]}

Viticchi, Giovanna ^{[38
]}

Ruzza, Giampietro ^{[39
]}

机构：

[1] Univ Laquila, Dept Biotechnol & Appl Clin Sci, Laquila, Italy

[2] ASST Cremona Hosp, Dept Neurol, Cremona, Italy

[3] Casa Sollievo Sofferenza, Dept Neurol, San Giovanni Rotondo, Italy

[4] Tor Vergata Univ Hosp, Dept Syst Med, Rome, Italy

[5] Citta Di Castello Hosp, Dept Neurol, Citta Di Castello, Italy

[6] Santa Corona Hosp, Dept Neurol, Pietra Ligure, Italy

[7] AOU Consorziale Policlin, Dept Neurol, Bari, Italy

[8] AOU Consorziale Policlin, Stroke Unit F Puca, Bari, Italy

[9] Venere Hosp, Dept Neurol, Bari, Italy

[10] Univ Hosp Santa Maria Misericordia, Stroke Unit, Perugia, Italy

[11] S Maria Croci Hosp, Dept Neurosci, AUSL Romagna, Ravenna, Italy

[12] ASST Ovest Milanese, Dept Neurol, Legnano, Italy

[13] Dept Neurol, AORN Antonio Cardarelli, Naples, Italy

[14] AORN Antonio Cardarelli, Stroke Unit, Naples, Italy

[15] IRCCS Ist Sci Neurolog Bologna, Dept Neurol, Policlin S Orsola Malpighi, Bologna, Italy

[16] S Eugenio Hosp, Dept Neurol, Rome, Italy

[17] S Eugenio Hosp, Stroke Unit, Rome, Italy

[18] Umberto I Hosp, Dept Neurol, Siracusa, Italy

[19] Umberto I Hosp, Stroke Unit, Siracusa, Italy

[20] Maggiore Hosp, IRCCS Ist Sci Neurolog Bologna, Dept Neurol, Bologna, Italy

[21] Maggiore Hosp, Stroke Ctr, Bologna, Italy

[22] Antonio Perrino Hosp, Dept Neurol, Brindisi, Italy

[23] Hosp E Agnelli, Dept Neurol, Pinerolo, Italy

[24] SS Biagio & Arrigo Hosp, Dept Neurol, Alessandria, Italy

[25] SS Biagio & Arrigo Hosp, Stroke Unit, Alessandria, Italy

[26] Fdn IRCCS San Gerardo Tintori Monza, Dept Neurol, Monza, Italy

[27] Osped Provinciale Madonna Soccorso, Neurol Unit, San Benedetto Tronto, Italy

[28] Giovanni Paolo II Hosp, Dept Neurol, Ragusa, Italy

[29] SS Annunziata Hosp, Dept Neurol, Chieti, Italy

[30] SS Annunziata Hosp, Stroke Unit, Chieti, Italy

[31] Univ G Annunzio Chieti Pescara, Dipartimento Med & Sci Invecchiamento, Chieti, Italy

[32] Osped Clinicizzato SS Annunziata Chieti, Clin Neurolog, Chieti, Italy

[33] Osped Clinicizzato S S Annunziata Chieti, Sroke Unit, Chieti, Italy

[34] San Jacopo Hosp, Dept Neurol, Pistoia, Italy

[35] Azienda Osped Univ Senese, Stroke Unit, Siena, Italy

[36] Univ Hosp Parma, Dept Emergency Neurol Stroke Care, Parma, Italy

[37] Osped Civile SS Giovanni & Paolo, Dept Neurol, Venice, Italy

[38] Marche Polytech Univ, Clin & Expt Med Dept, Ancona, Italy

[39] Cittadella Hosp, Stroke Unit, Cittadella, Italy

[40] Careggi Univ Hosp, Stroke Unit, Florence, Italy

[41] IRCCS C Mondino Fdn, Dept Emergency Neurol, Pavia, Italy

[42] IRCCS C Mondino Fdn, Stroke Unit, Pavia, Italy

[43] Univ Rome Sapienza, Dept Human Neurosci, Rome, Italy

[44] Univ Laquila, Dept Biotechnol & Appl Clin Sci, Via Vetoio 1, I-67100 Laquila, Italy

来源：

STROKE | 2023年 / 54卷 / 05期

关键词：

aspirin; clopidogrel; follow-up studies; prospective studies; ticagrelor; OF-HEALTH STROKE; SEX-DIFFERENCES; ASPIRIN; SCALE; CLOPIDOGREL; GUIDELINES;

D O I：

10.1161/STROKEAHA.122.041660

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs.Methods: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the ?(2) test.Results: We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria.Conclusions: The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose.

引用

页码：1172 / 1181

页数：10

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