DAPT noninferior to alteplase in minor nondisabling acute ischemic stroke

So both pretty much failed at 100% recovery but your writeup failed to acknowledge that, for that lie I'd fire you all. The only goal in stroke is 100% recovery, when will you get that thru your thick skulls?

DAPT noninferior to alteplase in minor nondisabling acute ischemic stroke

Key takeaways:

• At 90 days after minor nondisabling acute ischemic stroke, there was no difference in functional outcomes between treatment with DAPT or alteplase.
• Safety outcomes were slightly better with DAPT.

In patients with minor nondisabling acute ischemic stroke, treatment with dual antiplatelet therapy was noninferior to treatment with IV alteplase, according to the results of the ARAMIS trial.

The researchers randomly assigned 760 patients (median age, 64 years; 31% women) with minor nondisabling acute ischemic stroke — defined as NIH Stroke Scale score of 5 or less, plus 1 point or less on single-item scores such as vision, language, neglect or single limb weakness, and a score of 0 in the consciousness item — to DAPT or IV alteplase. The patients, who were treated at 38 hospitals in China, underwent randomization within 4.5 hours of symptom onset and had a median NIH Stroke Scale score of 2.

At 90 days after minor nondisabling acute ischemic stroke, there was no difference in functional outcomes between treatment with DAPT or alteplase.
Data were derived from Chen HS, et al. JAMA. 2023;doi:10.1001/jama.2023.7827.

The DAPT group received clopidogrel 300 mg and aspirin 100 mg on the first day followed by clopidogrel 75 mg and aspirin 100 mg for 12 days, and then guideline-based antiplatelet therapy until 90 days. The alteplase group received IV alteplase 0.9 mg/kg up to 90 mg on the first day followed by guideline-based antiplatelet therapy starting 24 hours after the alteplase dose.

The primary endpoint was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1, at 90 days.(1 is not excellent according to survivors, you can't let your stroke medical 'professionals' use the tyranny of low expectations on you!)

At 90 days, 93.8% of patients in the DAPT group and 91.4% of those in the alteplase group had excellent functional outcome (risk difference, 2.3%; 95% CI, –1.5 to 6.2; crude RR = 1.38; 95% CI, 0.81-2.32), Hui-Sheng Chen, MD, from the department of neurology, General Hospital of Northern Theatre Command in Shenyang, China, and colleagues wrote.

The unadjusted lower limit of the 97.5% CI was –1.5%, beating the noninferiority margin of –4.5% (P for noninferiority < .001), according to the researchers.

Symptomatic intracranial hemorrhage at 90 days occurred in one patient (0.3%) from the DAPT group and in three patients (0.9%) from the alteplase group, the researchers wrote.

Various sensitivity analyses did not change the results.

“This finding, along with better safety outcomes, provides robust evidence for the effectiveness of DAPT being noninferior to intravenous alteplase in patients with minor nondisabling acute ischemic stroke,” Chen and colleagues wrote.