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Introduction <p>Short-term use of dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for early outcomes in acute&#xa0;ischemic stroke (AIS). However, the long-term effects of SAPT and DAPT remain unclear. This study aimed to evaluate long-term effects of DAPT and SAPT on clinical outcomes in patients with AIS.</p> Methods <p>A retrospective cohort study was conducted at three tertiary hospitals in Saudi Arabia, including 912 patients with AIS who received either DAPT (aspirin plus clopidogrel) or SAPT (aspirin or clopidogrel alone). The primary outcome was the incidence of net adverse clinical and cerebral events (NACCEs), which was defined as the incidence of any hemorrhagic transformation within 30&#xa0;days, or stroke recurrence and/or all-cause mortality within 12&#xa0;months of the index stroke.</p> Results <p>Of 4043 screened patients, 912 met the inclusion criteria, with a mean age of 65.47&#xa0;years. Among them, 582 patients (63.8%) received DAPT. In the treatment selection model, patients with a more severe stroke presentation had lower odds of receiving DAPT. Over the 12-month period, there was no significant difference in the incidence of NACCEs between the DAPT and SAPT groups (<i>p</i> = 0.946). Additionally, the DAPT group showed a higher rate of stroke recurrence within the first 50&#xa0;days post stroke. In contrast, the SAPT group had higher hemorrhagic transformation and mortality. However, none of these associations were statistically significant (<i>p</i> = 0.1075, 0.0865, and 0.3121, respectively). In the adjusted Cox models, DAPT was not independently associated with stroke recurrence, hemorrhagic transformation, all-cause mortality, or the composite NACCE endpoint (<i>p</i> &gt; 0.05).</p> Conclusion <p>The addition of a second antiplatelet agent did not significantly reduce the long-term risk of stroke recurrence or mortality in patients with AIS over a 12-month period. Further studies are needed to assess long-term benefits and risks of DAPT in different stroke subpopulations.</p>

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Real-World Comparative Outcomes of Dual vs. Single Antiplatelet Therapy in Acute Ischemic Stroke: A Retrospective Cohort Analysis

  • 期刊论文

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  • 发表日期：

    2026年1月3日

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  • Yasser Alatawi,
  • Faisal F. Alamri,
  • Eman A. Alraddadi,
  • Sarah Algamedi,
  • Asail Alkhathami,
  • Ghaida Altowairqi,
  • Mehaf Ferak,
  • Khadijah Bamusa,
  • Amani Y. Alhalwani,
  • Salwa Y. Hafez,
  • Faisal Almutawa,
  • Alqassem Y. Hakami

摘要

Introduction

Short-term use of dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for early outcomes in acute ischemic stroke (AIS). However, the long-term effects of SAPT and DAPT remain unclear. This study aimed to evaluate long-term effects of DAPT and SAPT on clinical outcomes in patients with AIS.

Methods

A retrospective cohort study was conducted at three tertiary hospitals in Saudi Arabia, including 912 patients with AIS who received either DAPT (aspirin plus clopidogrel) or SAPT (aspirin or clopidogrel alone). The primary outcome was the incidence of net adverse clinical and cerebral events (NACCEs), which was defined as the incidence of any hemorrhagic transformation within 30 days, or stroke recurrence and/or all-cause mortality within 12 months of the index stroke.

Results

Of 4043 screened patients, 912 met the inclusion criteria, with a mean age of 65.47 years. Among them, 582 patients (63.8%) received DAPT. In the treatment selection model, patients with a more severe stroke presentation had lower odds of receiving DAPT. Over the 12-month period, there was no significant difference in the incidence of NACCEs between the DAPT and SAPT groups (p = 0.946). Additionally, the DAPT group showed a higher rate of stroke recurrence within the first 50 days post stroke. In contrast, the SAPT group had higher hemorrhagic transformation and mortality. However, none of these associations were statistically significant (p = 0.1075, 0.0865, and 0.3121, respectively). In the adjusted Cox models, DAPT was not independently associated with stroke recurrence, hemorrhagic transformation, all-cause mortality, or the composite NACCE endpoint (p > 0.05).

Conclusion

The addition of a second antiplatelet agent did not significantly reduce the long-term risk of stroke recurrence or mortality in patients with AIS over a 12-month period. Further studies are needed to assess long-term benefits and risks of DAPT in different stroke subpopulations.