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ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1568711
Renal function and efficacy of dual antiplatelet vs alteplase in minor stroke: A post hoc analysis of ARAMIS study
Provisionally accepted- General Hospital of Northern Theater Command, Shenyang, China
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Background: This secondary analysis of the ARAMIS trial evaluated renal function's modifying effects on therapeutic responses to dual antiplatelet therapy (DAPT) versus intravenous thrombolysis in acute minor ischemic stroke.Based on the as-treated set, we stratified patients by admission estimated glomerular filtration rate into three groups: normal renal function (≥ 90 mL/min/1.73 m 2 ), mildly decreased renal function (eGFR 60 to 89 mL/min/1.73 m 2 ), and moderate to severe impairment renal function group (< 60 mL/min/1.73 m 2 ). The primary endpoint was excellent functional outcome defined as a modified Rankin Scale score of 0-1 at 90 days.Results: Among 615 analyzed patients, 367 (59.7%) exhibited normal renal function，209 (34.0%) exhibited mildly decreased renal function and 39 (6.3%) exhibited moderate to severe impairment renal function. A numerically higher rate of excellent functional outcome was found in normal renal function patients with DAPT vs alteplase (94.4% vs 90.4%; P=0.147), while no intergroup difference emerged in mildly decreased renal function patients (93.9% vs 93.7%; P=0.958) and moderate to severe impairment renal function patients (93.8% vs 95.7%; P=0.792). There was no significant interaction between treatment and renal function on the primary outcome (adjusted interaction P=0.337).Among patients with normal renal function, DAPT was associated with a numerically higher, but not statistically significant, rate of excellent functional outcome in patients with minor nondisabling acute ischemic stroke presenting within 4.5 hours of symptom onset compared with alteplase.
Keywords: clinical outcome, dual antiplatelet, intravenous thrombolysis, Renal function, Minor stroke
Received: 30 Jan 2025; Accepted: 14 Apr 2025.
Copyright: © 2025 Chen, He and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hui-Sheng Chen, General Hospital of Northern Theater Command, Shenyang, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.