{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:00:07Z","timestamp":1790010007068,"version":"4.0.1"},"reference-count":22,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis Extra"],"abstract":"<jats:p>Introduction: Early neurological deterioration after ischemic stroke is associated with worse clinical outcome, yet little is known about the frequency and determinants of neurological worsening during the first 24 h after admission. Dual antiplatelet therapy (DAPT) is recommended early after minor non-cardioembolic stroke to reduce recurrent ischemic events, but its relationship with very early deterioration (vEND) and potential differences across stroke etiologies remain unclear. Methods: We conducted a retrospective single-center cohort study including consecutive adults with non-cardioembolic ischemic stroke admitted to a Swiss tertiary stroke center between 2014 and 2023. vEND was defined as neurological worsening within 24 h using 2 thresholds (NIHSS increase \u22654 points [primary] and \u22652 points [secondary]). Patients were categorized according to antiplatelet strategy (newly initiated DAPT vs. single antiplatelet therapy [SAPT]) and stroke etiology (large artery atherosclerosis [LAA] vs. non-LAA). Associations between antiplatelet therapy and vEND were analyzed using propensity score-weighted logistic regression with stabilized inverse probability of treatment weights and doubly robust adjustment. Adjusted predicted probabilities and risk differences were estimated using marginal standardization. Results: Among 1,207 patients with non-cardioembolic stroke, vEND occurred in 22.2% using the primary definition (NIHSS increase \u22654 points) and in 25.8% using the secondary definition (NIHSS increase \u22652 points). vEND was more frequent in non-LAA than LAA stroke under both definitions (23.5% vs. 17.6% and 26.4% vs. 23.7%, respectively). Patients with LAA were more likely to receive DAPT than those without LAA (33.6% vs. 14.4%, p &lt; 0.001). After weighting and adjustment, the association between antiplatelet therapy and vEND differed by stroke etiology (p&lt;sub&gt;interaction&lt;\/sub&gt;&lt;0.001 [primary] and p&lt;sub&gt;interaction&lt;\/sub&gt; = 0.007 [secondary]). In LAA stroke, DAPT was associated with a numerically lower risk of vEND compared with SAPT (adjusted risk difference [primary definition]: \u22127.3%, 95% CI: \u221216.9% to 2.3%). In contrast, among non-LAA stroke patients, DAPT was associated with a higher vEND risk (adjusted risk difference [primary definition]: 16.6%, 95% CI: 7.1%\u201326.1%). Similar patterns were observed using the secondary vEND definition (NIHSS increase of \u22652 points). Conclusion: Very early neurological deterioration within the first 24 h after non-cardioembolic stroke is common and occurs more frequently in non-LAA stroke. The association between DAPT and vEND appears to differ by stroke etiology. A lower risk was observed in LAA stroke, whereas the higher risk seen in non-LAA stroke likely reflects confounding by indication. Prospective studies are needed to determine whether intensified platelet inhibition may reduce vEND in LAA-related stroke.<\/jats:p>","DOI":"10.1159\/000552952","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:00:41Z","timestamp":1785340841000},"page":"255-263","source":"Crossref","is-referenced-by-count":0,"title":["Dual Antiplatelet Therapy and Very Early Neurological Deterioration after Non-Cardioembolic Stroke According to Stroke Etiology"],"prefix":"10.1159","volume":"16","author":[{"given":"Rosa Sruthy","family":"Pereppadan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Sch\u00e4rli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shania","family":"Br\u00fclisauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Valletta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Vlachos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Hellstern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolga D.","family":"Dittrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-308327"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.119.028287"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000010603"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000012661"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.119.027011"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1177\/1747493016650454"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033033"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/ene.70012"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.7827"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.0146"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036318"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(07)61602-x"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.24.1.35"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.07.018"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.108.532465"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1055\/a-2754-5302"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.114.302721"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1215340"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1800410"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2309137"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211000877"}],"container-title":["Cerebrovascular Diseases Extra"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000552952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:01:46Z","timestamp":1790006506000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000552952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000552952","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33110684","asserted-by":"subject"}]},"ISSN":["1664-5456"],"issn-type":[{"value":"1664-5456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}