ABSTRACT NUMBER: ESOC2026A1251 INTENSIVE TRIPLE ANTIPLATELET THERAPY VERSUS GUIDELINE THERAPY IN PATIENTS WITH CAROTID STENOSIS: DATA FROM THE TRIPLE ANTIPLATELET FOR REDUCING DEPENDENCY AFTER ISCHAEMIC STROKE (TARDIS) TRIAL

Abstract Background and aims Dual antiplatelet therapy reduces early recurrence in patients with acute non-cardioembolic minor ischaemic stroke or transient ischaemic attack (TIA). The effect of triple antiplatelet therapy in the presence of symptomatic carotid stenosis is unknown. We sought to assess the effect of triple vs. guideline antiplatelet therapy using data from the Triple Antiplatelet for Reducing Dependency after Ischaemic Stroke (TARDIS) trial. Methods TARDIS randomised 3096 patients within 48 hours of non-cardioembolic ischaemic stroke or TIA to triple antiplatelet therapy (aspirin-clopidogrel-dipyridamole) or guideline therapy (clopidogrel, or aspirin-dipyridamole) for 30 days. The primary outcome was stroke recurrence and its severity using the modified Rankin Scale (mRS) at day 90. Symptomatic ipsilateral carotid stenosis was split: <30%; 30-50%; 50-70%; >70%. Data are odds ratios (OR) with 95% confidence intervals (CI) adjusted for baseline prognostic factors. Results 2839/3096 (91.7%) participants had carotid imaging. Compared with participants with <30%, >70% symptomatic stenosis participants were older, more were male, current smokers, had hypertension, presented with ischaemic stroke versus TIA, a higher NIHSS, and underwent thrombolysis. At 90 days, stroke recurrence and its severity did not differ between participants with >70% symptomatic stenosis versus those with <30% stenosis: OR 1.28, 95% CI 0.69-2.38, p=0.43. Randomisation to triple vs. guideline antiplatelet therapy did not influence the primary outcome in participants with >70% symptomatic stenosis (OR 2.32, 95% CI 0.33-16.28, p=0.40) or other symptomatic stenosis groups. Conclusions Severe symptomatic carotid stenosis was not associated with stroke recurrence and its severity; triple vs. guideline antiplatelet therapy did not effect this. Conflict of interest JP Appleton: nothing to disclose; K Krishnan: nothing to disclose; LJ Woodhouse: nothing to disclose; TJ England: nothing to disclose; N Sprigg: nothing to disclose; PM Bath: nothing to disclose