Diabetes Mellitus and Early Antiplatelet Treatment for Minor Stroke Following Intravenous Thrombolysis: Prespecified Secondary Analysis of the EAST Trial

ABSTRACT Background Early dual antiplatelet therapy (DAPT) after intravenous thrombolysis is safe but ineffective in improving 90‐day functional outcomes in minor stroke. Given the effect of diabetes mellitus (DM) with antiplatelet treatment, we investigated whether DM status modifies the effect of early DAPT. Method This secondary analysis of the Early Antiplatelet for Minor Stroke following Thrombolysis trial included patients from the modified intention‐to‐treat population. Participants were stratified by DM status (history of DM, newly diagnosed DM, non‐DM). Outcomes were compared between early DAPT and placebo groups within each subgroup. The primary outcome was excellent functional outcome (modified Rankin Scale score 0–1) at 90 days. Results Among 995 analysed patients, early DAPT was associated with a significantly higher rate of excellent functional outcome in patients with a history of DM (91.2% vs. 81.7%; adjusted OR 2.76, 95% CI 1.22–6.22, p = 0.02). No significant benefit was observed in the newly diagnosed DM (81.8% vs. 83.3%; OR 1.20, 95% CI 0.24–5.95, p = 0.83) or non‐DM subgroups (89.6% vs. 92.5%; OR 0.70, 95% CI 0.41–1.17, p = 0.17). The interaction across subgroups was not significant ( p for interaction = 0.09). Conclusion For Chinese patients with minor stroke receiving intravenous thrombolysis, early DAPT was potentially associated with a higher likelihood of excellent functional outcome at 90 days in those with a pre‐existing history of DM. It warrants further confirmation. Trial Registration: ClinicalTrials.gov identifier: NCT05193071