A NEW systematic review and meta-analysis has assessed whether dual antiplatelet therapy (DAPT) offers significant benefits over single antiplatelet therapy (SAPT) for patients with minor stroke following thrombolysis. This research comes amid ongoing discussions about optimizing stroke recovery strategies, particularly after the recent TEMPO-2 trial found no benefit from intravenous thrombolysis in acute minor ischemic stroke.
Analyzing data from four qualifying studies among 4,364 initially retrieved, researchers examined outcomes in patients aged 18 and older with a National Institutes of Health Stroke Scale (NIHSS) score of ≤5. The primary endpoint was functional independence, measured by a modified Rankin Scale (mRS) score of 0–1 at 90 days. Findings revealed minimal difference between DAPT and SAPT in achieving this outcome (Risk Ratio (RR) 1.09; 95% Confidence Interval (CI) 0.98–1.21; p=0.11), indicating that DAPT does not provide a statistically significant advantage over SAPT in improving functional recovery.
Additionally, the study assessed the risk of symptomatic intracranial hemorrhage (SICH) and stroke recurrence. While results suggested a reduced risk of SICH (RR 0.65; 95% CI 0.11–3.97; p=0.64) and stroke recurrence (RR 0.88; 95% CI 0.44–1.78; p=0.64) in the DAPT group, these findings were not statistically significant.
The study concludes that while DAPT does not demonstrate clear superiority over SAPT, it may offer slight benefits in reducing stroke recurrence and SICH risk. Given the limitations of the current evidence base, further large-scale studies are needed to clarify the role of DAPT in post-thrombolysis stroke management.
Reference: Humayal M et al. Impact of dual antiplatelet therapy on patients with minor stroke after thrombolysis: a systematic review and meta-analysis. BMJ Neurology Open 2025;7:e000957.
Anaya Malik | AMJ
