Dual antiplatelet therapy for mild stroke: will lower blood pressure be better?

An introduction to the latest post-analysis results of the POINT trial showed that patients with mild stroke or high-risk transient ischemic attack (TIA) who have low blood pressure at the time of diagnosis will benefit more from dual antiplatelet therapy (DAPT)
.

The research results were published on JAMA Network Open on June 4
.

Yimaitong compiles and organizes, please do not reprint without authorization
.

 Review of previous results of the POINT study On May 16, 2018, the POINT study results announced at the European Stroke Organization Annual Meeting showed that compared with the use of aspirin alone, the dual antiplatelet therapy of clopidogrel + aspirin can reduce mild ischemia Stroke (small stroke) or high-risk TIA patients are at risk of serious ischemic events, but may increase the risk of major bleeding
.

The results of the study were published in the journal NEMJ at the same time
.

 Click to review more content ☟☟☟ The POINT study was released, and new evidence is added for the treatment of small strokes.
At the 2020 International Stroke Conference, the results of the POINT study will be updated again! The post-exploratory analysis of the POINT study aimed to explore the effect of dual-antibody treatment on the disability of patients.
The results of the study suggest that dual-antibody treatment can reduce the disabling events of small strokes
.

In addition, the results of the study also suggest that in addition to reducing acute small strokes and recurrent strokes in patients with TIA, DAPT can also reduce stroke-related disabilities
.

 Click to review more content ☟☟☟ Post-exploratory analysis of POINT study: dual-antibody treatment can reduce disabling events in small strokes.
At the 2021 International Stroke Conference, the post-analysis results of the POINT study showed that clopidogrel + aspirin dual antiplatelet Treatment (DAPT) can reduce the risk of stroke recurrence in mild stroke or transient ischemic attack (TIA)
.

And patients with infarct characteristics on CT or MRI have a greater risk reduction than patients without infarction
.

Click to review more content ☟☟☟ POINT trial post-analysis: Infarction indications can predict the efficacy and recurrence of dual antiplatelet therapy? Study introduction This cohort study performed a post-event subgroup analysis of the POINT trial, including patients with available blood pressure and endpoint data, and statistical analysis was performed from November 2020 to January 2021
.

According to the inclusion criteria of POINT, the patient's blood pressure was measured within 12 hours after the onset of symptoms
.

Researchers divide the systolic blood pressure (SBP) into two levels, <140 mm Hg and ≥140 mm Hg; for further analysis, it is divided into three levels (<140 mm Hg, 140-180 mm Hg and >180 mm Hg) , And allow the examination of patients with acute hypertension (>180 mm Hg) after stroke or TIA
.

 The primary outcome was an ischemic stroke event within 90 days of follow-up; the secondary outcome was (1) major hemorrhage, (2) major cardiovascular events (MACE), including ischemic stroke, myocardial infarction, vascular death or hemorrhage, and (3) Ischemic stroke events within 7 days after randomization; exploratory analysis uses diastolic blood pressure (DBP, divided into <90 mm Hg and ≥90 mm Hg) to verify the association
.

  Main findings: (1) The average age of the 4,781 patients enrolled was 64.
6 (13.
1) years old, 2,142 (44.
8%) were male, 3,487 (72.
9%) were white, and 266 (5.
6%) were mainly during the follow-up period.
The outcome was ischemic stroke
.

 (2) 946 (19.
8%) patients had a baseline SBP of less than 140 mm Hg, and 3,835 (80.
2%) patients had an SBP of ≥140 mm Hg
.

The interaction between SBP and treatment was significant (P interaction=0.
03)
.

In the subgroup with SBP<140 mm Hg, the risk ratio (HR) of DAPT and aspirin alone for ischemic stroke was 0.
36 (95%CI, 0.
18-0.
72; P=0.
004); while the HR of the SBP≥140mm Hg group It is 0.
79 (95%CI, 0.
60-1.
02; P=0.
08)
.

 (3) When assessing ischemic stroke events within randomized days, the interaction between SBP and treatment was significant (P interaction = 0.
02); the HR of SBP <140 mm Hg DAPT group was 0.
19 (95% CI, 0.
07-0.
55; P =0.
002)
.

 Conclusion In the POINT trial, patients with SBP <140 mm Hg at presentation and 90-day DAPT benefited more than patients with a higher baseline SBP, especially in reducing the recurrence of early ischemic stroke
.

But more research is needed to verify this result-whether lower SBP and DAPT within 12 hours after the onset of stroke will reduce the risk of early recurrence in stroke patients
.

 References: [1] Dual Antiplatelet Therapy in Mild Stroke: Better at Lower BP?-Medscape-Jun 08, 2021.
[2] De Havenon A, Johnston SC, Easton JD, et al.
Evaluation of Systolic Blood Pressure, Use of Aspirin and Clopidogrel, and Stroke Recurrence in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial.
JAMA Netw Open.
2021;4(6):e2112551.
doi:10.
1001/jamanetworkopen.
2021.
12551.
[3] Presence of Infarct Predicts Recurrence and Efficacy of Dual Antiplatelet Therapy: A Post-Hoc Analysis of the POINT Trial.
ISC2021.