Abstract Number: Esoc2026a360 Dual Antiplatelet Therapy Versus Intravenous Thrombolysis for Minor Ischemic Stroke: A Meta-Analysis of Randomized Clinical Trial and Observational Study

Abstract Background and aims The benefits of IVT in patients with minor or nondisabling symptoms are still debated due to potential concerns regarding intracranial hemorrhage. This systematic review and meta-analysis aims to comprehensively evaluate the treatment effects of dual antiplatelet therapy (DAPT) versus intravenous thrombolysis (IVT) in patients with acute minor ischemic stroke. Methods RCTs and observational studies that directly compared DAPT with IVT in patients with acute minor ischemic stroke were included. Our primary efficacy outcome was the proportion of patients with mRS scores 0–1 at 90 days. The primary safety outcome was the incidence of symptomatic intracranial hemorrhage (sICH). The study protocol was prospectively registered on PROSPERO (CRD420251121739). Results A total of 1 RCT and 6 observational studies with 7428 patients were included in the analysis. For efficacy outcomes, no significant differences were found in the proportion of mRS scores 0–1 at 90 days (OR 1.19, 95% CI 0.89–1.58; P=0.25), the proportion of mRS scores 0–2 at 90 days (OR 1.03, 95% CI 0.61–1.72; P=0.92), and stroke recurrence within 90 days (OR 0.87, 95% CI 0.57–1.33; P=0.51) between the groups. Regarding safety outcomes, sICH and mortality at 90 days were comparable between the DAPT group and IVT group. IVT was associated with a higher incidence of early neurological deterioration within 24 hours (OR 0.48, 95% CI 0.27–0.87; P=0.01). Conclusions In conclusion, our findings suggest that DAPT may be a preferable treatment for acute minor ischemic stroke due to its comparable efficacy and superior safety profile compared to IVT. Conflict of interest Nothing to disclose