Dual Antiplatelet Therapy in Acute Branch Atheromatous Disease (
BAD
)‐Related Stroke: A Multicenter Propensity‐Matched Cohort Analysis
Haizhou Hu, Shengde Li, Yu Zhang, Yuhui Sha, Yaping Zhou, Feng Feng, Yicheng Zhu, Lixin Zhou, Bin Peng, Jun Ni, ABSTRACT
Aims
The optimal antiplatelet regimen for branch atheromatous disease (BAD)‐related stroke remains uncertain. This study aimed to compare the clinical outcomes of dual antiplatelet therapy (DAPT) vs. single antiplatelet therapy (SAPT) in these patients.
Methods
From the multicenter prospective BAD‐study, we collected consecutive patients with BAD who received DAPT and SAPT. Propensity score matching (PSM) was used to balance baseline characteristics. The primary efficacy endpoint was an excellent outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The safety endpoint was bleeding events within 7 or 90 days.
Results
A total of 449 patients were enrolled in the analysis, with a median age of 60 years and a median National Institutes of Health Stroke Scale score of 3 at admission. After PSM, there were 112 patients in the SAPT group and 171 patients in the DAPT group, with well‐balanced baseline characteristics. Excellent outcome occurred in 69.6% of the SAPT group and 79.5% of the DAPT group (odds ratio, 0.590; 95% confidence interval, 0.341 to 1.022; p = 0.059). No significant differences were observed in other efficacy outcomes between the two groups. In exploratory subgroup analysis, no significant treatment‐by‐subgroup interactions were observed, and after correction for multiple comparisons, no within‐subgroup differences remained statistically significant. No increased bleeding risk was observed in DAPT.
Conclusion
In acute BAD‐related stroke, DAPT was safe but not statistically superior to SAPT for excellent functional outcome; however, its numerical trend toward benefit warrants further investigation.