ABSTRACT NUMBER: ESOC2026A1821 EARLY DUAL ANTIPLATELET THERAPY EFFECT ON OUTCOME AFTER THROMBOLYTIC THERAPY IN CAPSULAR WARNING SYNDROME

Abstract Background and aims Capsular warning syndrome(CWS) is a rare and serious pattern defined as recurrent lacunar transient syndrome. We aim to evaluate whether early initiation(as early as 4 hours) of dual antiplatelet therapy has any effect on the early outcome in patients with CWS after thrombolytic therapy. Methods We retrospectively evaluated patients who were admitted to the Saint Gregory Illuminator MC in 2024 and 2025 for acute stroke presenting with CWS. There were 11 patients(mean age=65.4, age range 47–83, SD=11.7) admitted of which 2 females and 9 males. According to our observation, the NIHSS score on admission was 9.0 ± 3.38, and as outcome of our treatment we chose the discharge NIHSS score, which was 0.82 ± 1.83. Dual antiplatelet therapy initiated were either Aspirin plus Clopdigorel for 2 patients and Aspirin plus Ticagrelor for 9 patients. Statistical analysis was performed using standard statistical methods. For evaluation of NIHSS score change Wilcoxon signed-rank test was used, and a p-value < 0.05 was considered statistically significant. Study was limited on sample size and absence of comparison group. Results According to our results NIHSS scores significantly improved from admission to discharge (p < 0.001), which shows benefit of early initiation of dual antiplatelet therapy. Conclusions Early initiation of dual antiplatelet therapy is associated with marked decrease in NIHSS score, which reflects improvement in neurological deficit. Given the observational nature of our study, small sample size, absence of comparison group these results should be interpreted with caution and there is need for larger, controlled studies. Conflict of interest Ani Madoyan: nothing to disclose Lusine Martirosyan: nothing to disclose