# Renal function and efficacy of dual antiplatelet vs. alteplase in minor stroke: a post hoc analysis of ARAMIS study

## TL;DR

This study found that kidney function does not significantly affect the effectiveness of two stroke treatments in patients with minor strokes.

## Contribution

The study provides new evidence on the lack of interaction between renal function and treatment outcomes in minor stroke patients.

## Key findings

- Patients with normal kidney function showed a trend toward better outcomes with DAPT compared to alteplase.
- No significant differences in outcomes were observed in patients with mildly decreased or severely impaired kidney function.
- The interaction between treatment and renal function was not statistically significant.

## Abstract

This secondary analysis of the ARAMIS trial evaluated renal function’s modifying effects on therapeutic responses to dual antiplatelet therapy (DAPT) versus intravenous thrombolysis in acute minor ischemic stroke.

Based on the as-treated set, we stratified patients by admission estimated glomerular filtration rate into three groups: normal renal function (≥90 mL/min/1.73 m2), mildly decreased renal function (eGFR 60 to 89 mL/min/1.73 m2), and moderate to severe impairment renal function group (<60 mL/min/1.73 m2). The primary endpoint was excellent functional outcome defined as a modified Rankin Scale score of 0–1 at 90 days.

Among 615 analyzed patients, 367 (59.7%) exhibited normal renal function, 209 (34.0%) exhibited mildly decreased renal function and 39 (6.3%) exhibited moderate to severe impairment renal function. A numerically higher rate of excellent functional outcome was found in normal renal function patients with DAPT vs. alteplase (94.4% vs. 90.4%; p = 0.147), while no intergroup difference emerged in mildly decreased renal function patients (93.9% vs. 93.7%; p = 0.958) and moderate to severe impairment renal function patients (93.8% vs. 95.7%; p = 0.792). There was no significant interaction between treatment and renal function on the primary outcome (adjusted interaction p = 0.337).

Among patients with normal renal function, DAPT was associated with a numerically higher, but not statistically significant, rate of excellent functional outcome in patients with minor nondisabling acute ischemic stroke presenting within 4.5 h of symptom onset compared with alteplase.

ClinicalTrials.gov, identifier NCT03661411.