ISC 2023 | ARAMIS: dual antiplatelet therapy non-inferior to alteplase in minor ischemic stroke

Thanh Nguyen, MD, Boston Medical Center, Boston University School of Medicine, Boston, MA, shares the findings of the ARAMIS randomized, controlled trial investigating the effect of dual antiplatelet treatment (DAPT) versus intravenous alteplase in patients with mild, non-disabling ischemic stroke. Minor strokes are a common occurrence, and the optimal management approach remains unclear. Evidence from the PRISMS trial in 2018 suggested that there was no significant difference in functional outcome in patients treated with alteplase compared to aspirin; however early termination of the trial prevented any definitive conclusions being drawn. Several trials have since shown the superiority of DAPT over aspirin in reducing 90-day disability and preventing recurrent strokes, and thus, ARAMIS aimed to test the efficacy of DAPT compared to alteplase in the early time window. Over 700 patients with an NIHSS score of ≤5 were randomized to receive clopidogrel plus aspirin or alteplase. DAPT was shown to be non-inferior to alteplase using a 4.5% noninferiority margin, with regards to the rate of excellent functional outcomes (93.8% mRS 0-1 in the DAPT group; 91.4% in the alteplase group). Prof. Nguyen shares her thoughts on what these data may mean for daily management of minor non-disabling stroke. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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