Abstract Details

Several studies report benefit of DAPT acutely after stroke to prevent early recurrence. However, DAPT is also associated with higher rates of CNS and other bleeding. There are likely additional factors that alter the risk/benefit ratio for the individual patient that should be considered when selecting treatment. Additionally, stroke patients often require procedures such as PEG placement or tracheostomy during their admission that require that these medications are held. It is unknown if the recent trend toward DAPT for acute stroke has led to delays and increased length of stay (LOS).

We evaluate the risks and benefits of dual antiplatelet therapy (DAPT) within our large, urban Comprehensive Stroke Center.

We reviewed our prospectively collected clinical research database of 1,316 patients presenting with ischemic stroke between 2016 and 2020. Cardioembolic strokes were removed. Patients were divided by treatment type: single antiplatelet (aspirin or clopidogrel) versus DAPT. Student’s t-tests and chi-squared analysis were used to evaluate differences in: CNS bleeding, other bleeding, recurrent stroke, readmission, length of stay, procedural delays, and oozing with procedures between groups. Multivariable regression analyses were used to adjust for age, vascular risk factors, stroke severity, etiology, and volume.

In multivariable regression, only stroke volume rather than treatment type was associated with increased CNS bleeding. There was no difference in other bleeding, recurrent stroke, or readmissions between groups. For those on DAPT, medications were more likely to need to be held prior to procedures (2.1% in single, 14.2% in dual) and there was significantly more oozing from the incision site. LOS was not impacted.

These data suggest that for patients with large ischemic strokes who are more likely to need a procedure, DAPT should be delayed to reduce the likelihood of intra- and extra-cranial bleeding.