Diabetes mellitus and efficacy of dual antiplatelet in acute ischemic stroke: A post hoc analysis of the ATAMIS trial.

We conducted a post hoc analysis of the ATAMIS (Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke) trial to evaluate whether diabetes mellitus (DM) status affects the efficacy of antiplatelet therapy in acute mild-to-moderate ischemic stroke. Using the modified intention-to-treat analysis set from the ATAMIS trial, patients were categorized into DM and non-DM subgroups. Outcomes were compared between the two antiplatelet treatments in each subgroup, and an interaction between DM status and treatment efficacy was assessed. The primary efficacy endpoint was early neurological deterioration (END) at 7 days, and safety endpoints included bleeding events and intracranial hemorrhage. A total of 2915 patients were included in this study. Compared with aspirin monotherapy, clopidogrel plus aspirin significantly reduced the incidence of END at 7 days in patients with DM (5.2 % versus 8.8 %; adjusted risk difference, -4.1 %; 95 % CI, -8.1 % to -0.1 %; P = 0.04), but not in those without DM (4.6 % versus 6.1 %; adjusted risk difference, -1.9 %; 95 % CI, -4.0 %-0.2 %; P = 0.07). No significant interaction was observed between DM status and treatment effect on the primary outcome (P = 0.38). Safety endpoints were similar between treatment groups, regardless of DM status. In patients with acute mild-to-moderate ischemic stroke, dual antiplatelet therapy was associated with a significant reduction in END at 7 days, specifically in the DM subgroup.