Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke

作者：Dawei Chen, Yu Cui, Zhonghe Zhou, Hong Zhang, Lixia Wang, Weizhong Wang, Liying Shen, Liyan Guo, Er-Qiang Wang, Ruixian Wang, Jing Han, Yu-Ling Dong, Jing Li, Yongzhong Lin, Qingcheng Yang, Li Zhang, Jingyu Li, Jin Wang, L. Xia, Guang-Bin Ma, Jiang Lu, Changhao Jiang, Shuman Huang, Li-Shu Wan, Hulin Piao, Zhuo Li, Yansong Li, Kui-Hua Yang, Duolao Wang, Thanh N. Nguyen, ARAMIS Investigators, Zhuo Gao, Hang Zhao, Xiaodong Liu, Xuewen Liu, Lihong Zhang, Ling Zhang, Li Li, Jia-Dong Zhang, Xinqiang Wang, Wenhai Yang, Shi-Mei Geng, Lian-Qiang Wang, Run-Hui Li · 发表于：JAMA · 年份：2023 · DOI：10.1001/jama.2023.7827 · 被引用次数：214 · 研究领域：Acute Ischemic Stroke Management、Antiplatelet Therapy and Cardiovascular Diseases、Atrial Fibrillation Management and Outcomes

Importance: Intravenous thrombolysis is increasingly used in patients with minor stroke, but its benefit in patients with minor nondisabling stroke is unknown. Objective: To investigate whether dual antiplatelet therapy (DAPT) is noninferior to intravenous thrombolysis among patients with minor nondisabling acute ischemic stroke. Design, Setting, and Participants: This multicenter, open-label, blinded end point, noninferiority randomized clinical trial included 760 patients with acute minor nondisabling stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5, with ≤1 point on the NIHSS in several key single-item scores; scale range, 0-42). The trial was conducted at 38 hospitals in China from October 2018 through April 2022. The final follow-up was on July 18, 2022. Interventions: Eligible patients were randomized within 4.5 hours of symptom onset to the DAPT group (n = 393), who received 300 mg of clopidogrel on the first day followed by 75 mg daily for 12 (±2) days, 100 mg of aspirin on the first day followed by 100 mg daily for 12 (±2) days, and guideline-based antiplatelet treatment until 90 days, or the alteplase group (n = 367), who received intravenous alteplase (0.9 mg/kg; maximum dose, 90 mg) followed by guideline-based antiplatelet treatment beginning 24 hours after receipt of alteplase. Main Outcomes and Measures: The primary end point was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 (range, 0-6), at 90 days. The noni...