Effectiveness and safety of dual antiplatelet therapy in patients with minor ischemic stroke or transient ischemic attack and cancer: A secondary analysis of the READAPT study.
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Foschi Matteo, De Santis Federico, D'Anna Lucio, Romoli Michele, Tassinari Tiziana, Saia Valentina, Cenciarelli Silvia, Bedetti Chiara, Padiglioni Chiara, Censori Bruno, Puglisi Valentina, Vinciguerra Luisa, Guarino Maria, Barone Valentina, Zedde Marialuisa, Grisendi Ilaria, Diomedi Marina, Bagnato Maria Rosaria, Petruzzellis Marco, Mezzapesa Domenico Maria, Inchingolo Vincenzo, Cappellari Manuel, Zivelonghi Cecilia, Candelaresi Paolo, Andreone Vincenzo, Rinaldi Giuseppe, Bavaro Alessandra, Cavallini Anna Maria, Piscaglia Maria Grazia, Terruso Valeria, Mannino Marina, Pezzini Alessandro, Frisullo Giovanni, Muscia Francesco, Paciaroni Maurizio, Mosconi Maria Giulia, Zini Andrea, Leone Ruggiero, Palmieri Carmela, Cupini Letizia Maria, Marcon Michela, Tassi Rossana, Sanzaro Enzo, Papiri Giulio, Viticchi Giovanna, Orsucci Daniele, Falcou Anne, Diamanti Susanna, Tarletti Roberto, Nencini Patrizia, Rota Eugenia, Sepe Federica Nicoletta, Ferrandi Delfina, Caputi Luigi, Volpi Gino, Laspada Salvatore, Beccia Mario, Rinaldi Claudia, Mastrangelo Vincenzo, Di Blasio Francesco, Invernizzi Paolo, Pelliccioni Giuseppe, De Angelis Maria Vittoria, Bonanni Laura, Ruzza Giampietro, Caggia Emanuele Alessandro, Russo Monia, Tonon Agnese, Acciarri Maria Cristina, Anticoli Sabrina, Roberti Cinzia, Manobianca Giovanni, Scaglione Gaspare, Pistoia Francesca, Fortini Alberto, De Boni Antonella, Sanna Alessandra, Chiti Alberto, Caggiula Marcella, Masato Maela, Del Sette Massimo, Passarelli Francesco, Bongioanni Maria Roberta, De Michele Manuela, Ricci Stefano, De Matteis Eleonora, Ornello Raffaele, Sacco Simona
Аннотация
PATIENTS AND METHODS: This was a secondary analysis of the prospective multicentric READAPT study (NCT05476081), including patients with non-cardioembolic minor ischemic stroke (NIHSS ⩽ 5) or high-risk TIA (ABCD2 ⩾4) who initiated DAPT within 48 h of symptom onset. The primary effectiveness outcome was the 90-day risk of new ischemic stroke or other vascular events (TIA, myocardial infarction, death due to vascular causes). Secondary outcomes included 90-day mRS score distribution and all-cause mortality. The primary safety outcome was the 90-day risk of any bleeding, with secondary safety outcomes including 24-h hemorrhagic transformation. We used Inverse Probability Weighting to compare outcomes between patients with and without cancer.
RESULTS: From 2278 patients in the READAPT study cohort, we included 1561 patients (mean age 70.3 ± 11.7 years; 65.4% males), of whom 206 (13.2%) had cancer, categorized as either active (27.7%) or in remission (72.3%). After weighting, overall cancer patients had a higher risk of 90-day new ischemic stroke or other vascular events (weighted HR 1.78, 95% CI 1.20-2.63, p = 0.004) and worse 90-day mRS score distribution (OR 1.24, 95% CI 1.10-1.41, p < 0.001) compared to patients without cancer. The 90-day risk of bleeding did not differ between cancer and no-cancer groups overall. When analyzing cancer subgroups, patients with active cancer had significantly higher risk of 90-day ischemic stroke or other vascular (weighted HR 2.75, 95% CI 1.70-4.45, p < 0.001) and any bleeding (weighted HR 2.51, 95% CI 1.27-4.97, p = 0.008) events compared to no-cancer patients. In contrast, patients with cancer in remission had comparable risks to those without cancer. Furthermore, hematological malignancies were associated with a substantially higher risk of 90-day new ischemic stroke or other vascular events compared to solid tumors (weighted HR 8.15, 95% CI 5.06-13.14, p < 0.001).
CONCLUSIONS: Patients with minor ischemic stroke or high-risk TIA and active cancer have increased risk of ischemic and bleeding events after DAPT. Conversely, patients with cancer in remission have similar outcomes compared to those with no cancer.