Article Figures & Data
- Figure 1
Flowchart showing patient selection.
- Figure 2
Distribution of mRS scores at 3-month follow-up among non-APT, SAPT and DAPTs. APT, antiplatelet therapy; DAPT, dual APT; mRS, modified Rankin Scale; SAPT, single APT.
- Table 1
Baseline and procedural characteristics
Characteristics All patients (n=915) Non-APT (n=716) APT P value* P value† Total (n=199) SAPT (n=137) DAPT (n=62) Age, mean+SD 64 (55–72) 64 (55–73) 62 (55–69) 62 (55–69) 62 (57–69.25) 0.095 0.248 Male 611 (66.8) 465 (64.9) 146 (73.4) 97 (70.8) 49 (79) 0.026 0.043 SBP, mean+SD 147 (130–161) 146 (130–160) 148 (134–161) 145 (132.5–161) 151.5 (139.5–165.5) 0.593 0.197 Admission NIHSS, median (IQR) 14 (9–20) 14 (9–20) 15 (10–20) 15 (11–22) 14 (4.75–18.25) 0.975 0.083 ASPECTS (anterior circulation only), median (IQR) 8 (7–8) 8 (7–8) 8 (7–8) 7 (7–8) 8 (7–10) 0.78 0.005 Vascular risk factors Atrial fibrillation 164 (17.9) 135 (18.9) 29 (14.6) 23 (16.8) 6 (9.7) 0.164 0.182 Diabetes mellitus 145 (15.8) 112 (15.6) 33 (16.6) 23 (16.8) 10 (16.1) 0.748 0.943 Previous stroke 97 (10.6) 75 (10.5) 22 (11.1) 12 (8.8) 10 (16.1) 0.814 0.286 Hypertension 499 (54.5) 378 (52.8) 121 (60.8) 80 (58.4) 41 (66.1) 0.045 0.08 Smoking 311 (34) 244 (34.1) 67 (33.7) 39 (28.5) 28 (45.2) 0.914 0.07 Drinking 142 (15.5) 109 (15.2) 33 (16.6) 23 (16.8) 10 (16.1) 0.639 0.89 TOAST classification Large artery atherosclerosis 649 (70.9) 501(70) 148 (74.4) 102 (74.5) 46 (74.2) 0.227 0.481 Small perforator 0 (0) Cardiogenic 168 (18.4) 138 (19.3) 30 (15.1) 22 (16.1) 8 (12.9) 0.176 0.347 Other aetiology 10 (1.1) 6 (0.8) 4 (2) 4 (2.9) 0 (0) 0.307 0.094 Unknown aetiology 88 (9.6) 71 (9.9) 17 (8.5) 9 (6.6) 8 (12.9) 0.561 0.315 Occlusion site ICA 266 (29.1) 225 (31.4) 62 (31.2) 46 (33.6) 16 (25.8) 0.942 0.548 M1 489 (53.4) 267 (37.3) 69 (34.7) 45 (32.8) 24 (38.7) 0.498 0.58 M2/3 160 (17.5) 66 (9.2) 18(9) 9 (6.6) 9 (14.5) 0.941 0.198 ACA 5 (0.5) 3 (04) 2 (1) 2 (1.5) 0 (0) 0.321 0.309 PCA 17 (1.9) 16 (2.2) 1 (0.5) 0 (0) 1 (1.6) 0.192 0.058 BA 93 (10.2) 70 (9.8) 23 (11.6) 19 (13.9) 4 (6.5) 0.462 0.217 VA 93 (10.2) 69 (9.6) 24 (12.1) 16 (11.7) 8 (12.9) 0.317 0.585 Anterior circulation stroke (n%) 712 (77.8) 561 (78.4) 151 (75.9) 102 (74.5) 49(79) 0.458 0.586 Posterior circulation stroke (n%) 203 (22.2) 155 (21.6) 48 (24.1) 35 (25.5) 13(21) 0.458 0.586 OTD time, median (IQR), min 180 (105–297) 180 (102.25–285) 180 (120-300) 180 (120–300) 176 (88.75–332.5) 0.55 0.822 DTP time, median (IQR), min 110 (70–160) 110 (70–160) 115 (70–170) 110 (76–155) 126.5 (52.25–186.25) 0.386 0.62 PTR time, median (IQR), min n=911, 80 (50–112) 80 (55–115) 70 (44.25–110) 78 (50–122.5) 65 (30–90) 0.033 0.001 OTP time, median (IQR), min 315 (220–440) 310 (220–430) 345 (201–460) 340 (227–449.5) 379.5 (180–491.25) 0.25 0.508 OTR time, median (IQR), min n=911, 403 (300–540) 400 (301.5–530) 417.5 (300–562.5) 406 (327.5–547.5) 440 (242.5–602.5) 0.491 0.655 Periprocedural other antithrombotic and anticoagulant Bridging IVT 241 (26.3) 211 (29.5) 30 (15.1) 19 (13.9) 11 (17.7) 0.000 0.000 Tirofiban 308 (33.7) 197 (27.5) 111 (55.8) 80 (58.4) 31 (50) 0.000 0.000 Heparin during EVT 367 (40.1) 283 (39.5) 84 (42.2) 51 (37.2) 33 (53.2) 0.494 0.081 Procedures characteristics General anaesthesia 331 (36.2) 239 (33.4) 92 (46.2) 67 (48.9) 25 (40.3) 0.001 0.002 MT stent retrieval 645 (70.5) 497 (69.4) 148 (74.4) 105 (76.6) 43 (69.4) 0.175 0.231 MT aspiration 60 (6.6) 31 (4.3) 29 (14.6) 21 (15.3) 8 (12.9) 0.000 0.000 Intra-arterial thrombolysis 189 (20.7) 162 (22.6) 27 (13.6) 16 (11.7) 11 (17.7) 0.005 0.013 Balloon angioplasty 85 (9.3) 66 (9.2) 19 (9.5) 17 (12.4) 2 (3.2) 0.887 0.083 Stent angioplasty 134 (14.6) 109 (15.2) 25 (12.6) 15 (10.9) 10 (16.1) 0.348 0.407 Boldface type indicates statistical significant.
*P value between non-APT and APT group.
†P value between non-APT, SAPT and DAPT groups.
ACA, anterior cerebral artery; APT, antiplatelet; ASPECTS, Alberta Stroke Program Early CT score; BA, basilar artery; DAPT, dual antiplatelet; DTP, door-to-puncture; EVT, endovascular treatment; ICA, internal carotid artery; IVT, intravenous thrombolysis; M1, middle cerebral artery M1 segment; M2/3, middle cerebral artery M2/3 segment; NIHSS, National Institutes of Health Stroke Scale score; OTD, onset-to-door; OTP, onset-to-puncture; OTR, onset-to-recanalisation; PCA, posterior cerebral artery; PTR, puncture-to-recanalisation; SAPT, single antiplatelet; SBP, systolic blood pressure; TOAST, trial of ORG 10172 in acute stroke treatment; VA, vertebral artery.
- Table 2
Safety and efficacy of pretreatment oral APT in all patients
Characteristics All patients (n=915) Non-APT (n=716) APT P value* P value† Total (n=199) SAPT (n=137) DAPT (n=62) Postoperative haemorrhage sICH 51 (5.6) 44 (6.1) 7 (3.5) 3 (2.2) 4 (6.5) 0.153 0.114 Recanalisation status Successful recanalisation mTICI 2b/3 838 (91.6) 650 (90.8) 188 (94.5) 128 (93.4) 60 (96.8) 0.097 0.135 Complete recanalisation mTICI 3 642 (70.2) 488 (68.2) 154 (77.4) 111(81) 43 (69.4) 0.012 0.01 Functional outcome at 3 months Excellent outcome (mRS 0–1) 382 (41.7) 294 (41.1) 88 (44.2) 53 (38.7) 35 (56.5) 0.424 0.046 Functional independence (mRS 0–2) 473 (51.7) 372(52) 101 (50.8) 62 (45.3) 39 (62.9) 0.764 0.067 Mortality (mRS 6) 160 (17.5) 127 (17.7) 33 (16.6) 30 (21.9) 3 (4.8) 0.704 0.004 *P value between non-APT and APT group.
†P value between non-APT, SAPT and DAPT group.
APT, antiplatelet; DAPT, dual antiplatelet; mRS, modified Rankin score; mTICI, modified treatment in cerebral infarction; SAPT, single antiplatelet; sICH, symptomatic intracranial haemorrhage.
- Table 3
Adjusted OR/HR of safety and efficacy outcomes in different treatment groups
Outcomes Groups Adjusted OR/HR (95% CI) P value sICH Non-APT Ref SAPT 0.185 (0.012 to 2.859) 0.227 DAPT 17.44 (0.519 to 586.332) 0.111 Total APT 0.781 (0.103 to 5.944) 0.811 Successful recanalisation (mTICI 2b/3) Non-APT Ref SAPT 1.883 (0.503 to 7.044) 0.347 DAPT 0.531 (0.055 to 5.090) 0.583 Total APT 1.410 (0.452 to 4.396) 0.554 Complete recanalisation (mTICI 3) Non-APT Ref SAPT 2.586 (1.002 to 6.674) 0.05 DAPT 0.396 (0.115 to 1.363) 0.142 Total APT 1.384 (0.628 to 3.053) 0.42 Primary outcome: mRS score at 90 days Non-APT Ref SAPT 0.750 (0.0543 to 1.035) 0.080 DAPT 1.662 (1.048 to 2.638) 0.031 Total APT 0.976 (0.740 to 1.287) 0.864 mRS 0–1 Non-APT Ref SAPT 1.887 (0.806 to 4.417) 0.143 DAPT 5.405 (1.614 to 18.102) 0.006 Total APT 2.605 (1.244 to 5.455) 0.011 mRS 0–2 Non-APT Ref SAPT 1.127 (0.469 to 2.708) 0.790 DAPT 2.397 (0.690 to 8.330) 0.169 Total APT 1.418 (0.661 to 3.041) 0.369 mRS 6 Non-APT Ref SAPT 1.159 (0.290 to 4.634) 0.835 DAPT 0.008 (0.000 to 0.441) 0.019 Total APT 0.514 (0.147 to 1.797) 0.297 Adjusted for sex, systolic blood pressure, NIHSS, ASPECTS, atrial fibrillation, hypertension, smoking, other aetiology of TOAST classification, MCA M2/3 segment occlusion site, intravenous thrombolysis, tirofiban, heparin use during, puncture to recanalisation, general anaesthesia, mechanical aspiration and intra-arterial thrombolysis and balloon angioplasty.
aICH, asymptomatic intracranial haemorrhage; APT, antiplatelet; ASPECTS, Alberta Stroke Program Early CT Score; DAPT, dual antiplatelet; MCA, middle cerebral artery; mRS, modified Rankin score; mTICI, modified treatment in cerebral infarction; NIHSS, National Institutes of Health Stroke Scale; SAPT, single antiplatelet; sICH, symptomatic intracranial haemorrhage.
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
