Neurology · 4 h ago
Post hoc ATAMIS analysis finds greater DAPT benefit in moderate stroke
A post hoc analysis of the randomized ATAMIS trial included 2,915 patients with mild or moderate ischemic stroke. Clopidogrel plus aspirin was associated with less early neurological deterioration in moderate, but not mild, stroke; the authors say prospective confirmation is needed.
- Analysis included 2,915 ATAMIS participants.
- DAPT was associated with fewer early deteriorations in moderate stroke.
- No significant difference was found in mild stroke.
- Prospective confirmation is needed.
This prespecified post hoc analysis used the modified intention-to-treat population of the randomized ATAMIS trial (NCT02869009), comparing clopidogrel plus aspirin with aspirin alone in acute ischemic stroke. The 2,915 participants were classified by baseline NIHSS score as having mild stroke (4–5; 1,992 patients) or moderate stroke (6–10; 923 patients). The primary outcome was early neurological deterioration, defined as an NIHSS increase of at least 2 points by day 7. Bleeding and intracranial hemorrhage through 90 days were safety outcomes.
In the moderate-stroke subgroup, dual antiplatelet therapy was associated with lower odds of early deterioration than aspirin alone (adjusted odds ratio, 0.31; 95% CI, 0.17–0.59). No significant difference was found in the mild-stroke subgroup (adjusted odds ratio, 0.96; 95% CI, 0.66–1.41). The treatment-by-severity interaction was significant (P=0.003). Bleeding and intracranial hemorrhage rates were similar between treatment groups in both subgroups.
The findings suggest that baseline stroke severity may modify the association between treatment and early neurological deterioration. However, this is a post hoc subgroup analysis, and the authors call for confirmation in prospective studies; it does not establish that treatment should be selected differently based on severity.
In practice
For patients with acute ischemic stroke in the NIHSS 4–10 range, this post hoc ATAMIS analysis found that clopidogrel plus aspirin was associated with lower odds of 7-day neurological deterioration in the moderate subgroup (NIHSS 6–10), but not the mild subgroup (NIHSS 4–5); bleeding outcomes were similar. The results raise the possibility that baseline severity modifies treatment effect, but do not establish a change in antiplatelet selection. Confirmation in prospective studies is needed.
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Stroke: Dual Versus Mono Antiplatelet Therapy in Mild Versus Moderate Ischemic Stroke: A Post Hoc Analysis of the ATAMIS Randomized Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.