Early dual antiplatelet therapy (DAPT) following intravenous thrombolysis may be associated with improved functional outcomes in patients with minor stroke who have pre-existing diabetes, according to findings published in Diabetes, Obesity and Metabolism. The benefit was not observed in individuals without diabetes or those with newly diagnosed diabetes.

This secondary analysis used data from the Early Antiplatelet for Minor Stroke following Thrombolysis trial and included 995 patients from the modified intention-to-treat population. Participants were categorized into three groups based on diabetes status: prior diabetes, newly diagnosed diabetes, and no diabetes. Outcomes were compared between patients receiving early DAPT and those receiving placebo within each subgroup. The primary endpoint was an excellent functional outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days.

In patients with a history of diabetes, early DAPT was associated with a higher rate of excellent functional outcome compared with placebo (91.2% vs 81.7%; adjusted OR 2.76; 95% CI 1.22-6.22; P=0.02). No significant differences were observed in the newly diagnosed diabetes group (81.8% vs 83.3%; OR 1.20; 95% CI 0.24-5.95; P=0.83) or in those without diabetes (89.6% vs 92.5%; OR 0.70; 95% CI 0.41-1.17; P=0.17). The interaction across subgroups was not statistically significant (P=0.09).

These findings suggest a potential subgroup-specific association between early DAPT and improved outcomes in patients with prior diabetes, although confirmation in further studies is required.