By Matthew E. Fink, MD

Feil Professor and Chairman, Department of Neurology, and Assistant Dean of Clinical Affairs, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports no financial relationships relevant to this field of study.

SOURCE: Cucchiara B, Elm J, Easton JD, et al. Disability after minor stroke and transient ischemic attack in the POINT trial. Stroke 2020;51:792-799.

Early treatment of minor stroke and transient ischemic attacks (TIAs) with antiplatelet medication reduces the risk and severity of recurrent stroke. The POINT trial demonstrated that dual antiplatelet treatment with aspirin and clopidogrel resulted in a lower rate of recurrent stroke than with aspirin alone. The investigators conducted a secondary analysis to determine if disability at 90 days was different between the two groups as well.

At 90 days, 9.6% of patients enrolled with TIA and 18.2% of patients enrolled with minor stroke were disabled. Overall disability was similar between the groups whether assigned to dual antiplatelet therapy or aspirin alone (14.7% vs. 14.3%). However, there were fewer patients with disability in conjunction with the primary outcome event in the dual antiplatelet treatment arm, but this did not reach statistical significance. The investigators also analyzed the combination of the index event with recurrent stroke and thought that there was a decrease in disability in the dual antiplatelet treatment arm. A multivariate analysis was performed and indicated that risk factors for disability following TIA included age, subsequent stroke, serious adverse events, and major bleeding. Although the data from this analysis suggest disability might be less with dual antiplatelet therapy, differences between the groups were small, did not show robust findings, and did not reach statistical significance in most of the analyses.