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Dual versus single antiplatelet therapy for secondary prevention in ischaemic stroke or transient ischaemic attack: A retrospective cohort study using real-world data
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  • Norazida Ab Rahman,
  • Wan Chung Law,
  • Wan Asyraf Wan Zaidi,
  • Zariah Abdul Aziz,
  • Norsima Nazifah Sidek,
  • Irene Looi ,
  • Ming Tsuey Lim,
  • Sarah Hui Li Pang,
  • Wen Yea Hwong,
  • Sheamini Sivasampu
Norazida Ab Rahman
Institute for Clinical Research
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Wan Chung Law
Sarawak General Hospital
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Wan Asyraf Wan Zaidi
Universiti Kebangsaan Malaysia Medical Centre
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Zariah Abdul Aziz
Hospital Sultanah Nur Zahirah
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Norsima Nazifah Sidek
Hospital Sultanah Nur Zahirah
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Irene Looi
Hospital Seberang Jaya
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Ming Tsuey Lim
Institute for Clinical Research
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Sarah Hui Li Pang
Institute for Clinical Research
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Wen Yea Hwong
Institute for Clinical Research
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Sheamini Sivasampu
Institute for Clinical Research
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Abstract

Objective: This study aimed to assess effectiveness and safety outcomes of antiplatelet therapy for secondary prevention among patients with ischaemic stroke or transient ischaemic attack (TIA) in Malaysia. Method: Patients with a first ischaemic stroke/TIA between 2014 and 2017 were identified from stroke registry and data was linked with other data sources for information on antiplatelet exposure and outcome events. Exposure was defined as antiplatelet therapy at discharge from the index stroke hospitalisation and categorised into single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) groups. Primary outcome was composite events of stroke, myocardial infarction, and all-cause death at up to one year after the index stroke in an intention-to-treat analysis. Results: Of 4434 patients included in the analysis, 6.7% were treated with DAPT and 93.3% were in SAPT group. During the 1-year follow-up, composite events occurred in 5.7% of patients in DAPT group and in 12.3% of SAPT (p<0.001). The rates of individual events were lower in DAPT group compared to SAPT: recurrent stroke (3.4% versus 4.8%), myocardial infarction (0.7% versus 1.9%), and all-cause death (1.7% versus 6.0%). Bleeding occurred in 1.3% of the DAPT group versus 1.6% of the SAPT. Multivariable-adjusted Cox regression analysis showed that rates of composite outcome was lower in the DAPT group compared to SAPT (HR 0.53, 95%CI 0.32, 0.86). Conclusion: In patients with ischaemic stroke/TIA, treatment with DAPT following the index stroke was associated with reduced risk of the composite events of stroke, myocardial infarction, and death. There appears to be similar risk of bleeding with DAPT versus SAPT.