Effects Of Dual Antiplatelet Therapy Of Different Duration On Recurrence And Functional Prognosis Of Non-cardiogenic Acute Minor Stroke

Objective: To explore the effects of dual antiplatelet therapy of different durations in the real world on the recurrence and functional prognosis of noncardiogenic acute minor stroke(MS).Methods: This study is a real-world,prospective,single center study,patients with non-cardiogenic acute minor stroke within 7 days of onset and using dual antiplatelet therapy(DAPT)(aspirin+clopidogrel)were continuously collected from the Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from November 2018 to October 2020.The patients were followed up for 24 months,including the duration of dual antiplatelet therapy,medication compliance,safety adverse events,ischemic stroke and modified rankin scale(m RS)scores at 30,90 and 180 days.Results: 1.A total of 268 patients were collected in this study,265 cases were followed up,3 cases were lost to follow-up,56 cases were treated with dual antiplatelet therapy for 21 days,65 cases were treated with dual antiplatelet therapy for < 21 days,145 cases were treated with dual antiplatelet therapy for >21 days,223 cases(84.2%)had no recurrence,42 cases(15.8%)had recurrence,and 13 cases(4.9%)had safety adverse events.All patients without recurrence were followed up for more than 6 months,and the longest follow-up time was24 months.2.There were at least two groups of differences in survival status,survival time,90 days and 180 days functional prognosis between different dual antiplatelet therapy durations(P<0.05).3.For patients with different dual antiplatelet durations,the Kaplan-meier method was used to draw the survival curve,and the Log-Rank test was used for pairwise comparison,the results showed that the recurrence of ischemic stroke rate of DAPT<21 days was significantly higher than that of DAPT 21 days.The recurrence of ischemic stroke rate of DAPT <21 days was significantly higher than DAPT>21 days,the difference was statistically significant(P<0.05).4.The duration of DAPT,trial of org 10172 in acute stroke treatment(TOAST)classification,age,stroke history,2 hours postprandial blood glucose(2h PBG)and the first determination of creatine kinase isoenzymes(CK-MB)can be known by multi-factor COX regression analysis:(1)The recurrence risk of MS with DAPT < 21 days was significantly higher than that with DAPT 21 days,with HR and 95% CI of 3.241(1.221,8.605),respectively.(2)The risk of MS recurrence was significantly higher in patients aged ≥ 75 years old than in patients aged < 75 years old(P =0.011).The HR and 95% CI were 2.856(1.278,6.381).(3)There was a positive correlation between the increase of CK-MB and MS recurrence.The HR and 95%CI were 2.977(1.111,7.979).(4)Compared with large artery atherosclerosis(LAA),the risk of MS recurrence of stroke of other determined cause(ODC)was significantly higher,small artery occlusion(SAO)type and stroke of undetermined cause(UND)type was compared with LAA type,and the difference was not statistically significant.5.Multivariate logistic regression analysis showed that: factors affecting the 30 days functional prognosis of MS include:(1)Compared with DAPT 21 days,DAPT < 21 days had P value of0.023,OR value and 95% CI of 2.872(1.156,7.132),suggesting that DAPT < 21 days had higher risk of poor prognosis than DAPT 21 days.(2)Compared with the first NIHSS score of 0,the scores of 2 and 3 groups of national institutes of health stroke scale(NIHSS)were 0.006 and 0.001,respectively,and the OR and95% CI were 6.364(1.718,23.584)and 9.517(2.623,34.527),suggesting that the risk of poor prognosis in 30 days of the three groups was higher than that in the first NIHSS score of 0.(3)Compared with DAPT > 24 h and DAPT ≤ 24 h,the P value of Cox regression test was 0.002,the or value and 95% CI were 0.399(0.221,0.722),indicating that the risk of poor prognosis in 30 days with DAPT >24h was higher than that with DAPT ≤ 24 h.Factors affecting the 90 days functional prognosis of MS include:(1)Compared with DAPT 21 days,DAPT <21 days had P value of 0.046,OR value and 95% CI of 2.951(1.019,8.543),suggesting that the risk of poor 90 day functional prognosis of DAPT < 21 days was higher than DAPT 21 days.(2)The first NIHSS score of 3 groups compared with the first NIHSS score of 0 points,the P value was 0.044,OR value and 95%CI were 3.951(1.035,15.075),suggesting that the risk of poor 90 days functional prognosis of the first NIHSS score of 3 groups was higher than that of the first NIHSS score of 0 points.(3)The P value of hypertension history was0.011,and its OR value and 95% CI were 4.975(1.441,17.176),suggesting that hypertension was a risk factor for poor 90 days functional prognosis.(4)The P value of history of hyperlipidemia was 0.017,and its OR value and 95% CI were2.618(1.188,5.767),suggesting that hyperlipidemia was a risk factor for poor 90 days functional prognosis.Factors affecting the 180 days functional prognosis of MS include:(1)DAPT < 21 days and DAPT > 21 days compared with DAPT 21 days,the difference was not statistically significant.(2)The P value of stroke history was 0.004,and its OR value and 95% CI were 3.316(1.483,7.414),suggesting that stroke history was a risk factor for poor 180 days functional prognosis.(3)The P value of age was 0.028,and the OR value and 95% CI were3.091(1.133,8.437),respectively.It suggested that the risk of poor 180 days functional prognosis in patients older than 75 years old was higher than that in patients younger than 75 years old.Conclusion: In the real world,21 days of dual antiplatelet therapy can relatively reduce the recurrence risk of minor stroke and improve the 30 days and 90 days functional prognosis.21 days of dual antiplatelet therapy may still be the best target for secondary prevention of non-cardiogenic minor stroke in the real world.