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

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.