Early antiplatelet treatment for minor stroke following thrombolysis: the EAST trial.
European Heart Journal · 2025-09-20 · Randomised trial
Abstract
BACKGROUND AND AIMS: Antiplatelet treatment is recommended to start 24 h after intravenous thrombolysis due to concerns about haemorrhagic transformation. This study aimed to investigate the potential benefit of early antiplatelet after intravenous thrombolysis in minor stroke. METHODS: A multicentre, double-blind, randomized trial was conducted in China between 7 August 2022 and 1 August 2024, to evaluate the efficacy and safety of early antiplatelet in acute ischaemic stroke patients presenting with mild neurological deficits, as indicated by a National Institutes of Health Stroke Scale (NIHSS) score of 0-5, who received intravenous thrombolysis. Patients were randomly assigned to receive either clopidogrel and aspirin or placebo within 6 h after intravenous thrombolysis. The primary endpoint was an excellent functional outcome at 90 days, indicated by a modified Rankin Scale (mRS) score of 0-1. Statistical analysis was based on a modified intention-to-treat population. Symptomatic intracranial haemorrhage, any intracranial haemorrhage, and major systemic bleeding were safety endpoints. RESULTS: The primary endpoint was not met in this study. Of the randomly assigned 1022 patients, 995 patients were included in the modified intention-to-treat analysis (503 with early antiplatelet treatment and 492 with placebo). The primary endpoint occurred in 89.7% (451/503) of patients receiving early antiplatelet vs 89.6% (441/492) of those receiving placebo with no significant difference (odds ratio 1.00, 95% confidence interval .67-1.51, P = .99). Similar safety profiles were found between the two groups. CONCLUSIONS: Among Chinese patients with acute minor ischaemic stroke who received intravenous thrombolysis, early antiplatelet treatment with clopidogrel plus aspirin was safe but did not improve already excellent functional outcome (mRS 0-1) at 90 days.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Antithrombotics & thrombolytics · Acetylsalicylic acid · P2Y12 inhibitors · Thrombolytics · Quality of life & function
Related articles
- Dual antiplatelet therapy pretreatment in patients undergoing intravenous thrombolysis for acute ischemic stroke: a systematic review and meta-analysis of 296,854 patients. (Neurol Res, 2026)
- Navigating the waters of acute minor stroke therapies: a systematic review and network meta-analysis. (J Thromb Haemost, 2025)
- Dual antiplatelet therapy after intravenous thrombolysis for patients with minor ischemic stroke：A meta-analysis. (Clin Neurol Neurosurg, 2024)
- Ticagrelor with aspirin dual antiplatelet therapy combined with intravenous thrombolysis in patients with ischaemic stroke in China (TAPIS): a multicentre, double-blind, randomised controlled trial. (Lancet, 2026)
- Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke: The ARAMIS Randomized Clinical Trial. (JAMA, 2023)
- Optimal pharmacological therapy for minor acute ischemic stroke: a network meta-analysis. (Front Neurol, 2026)