Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials.

Autor:	Ahmed M; Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan., Ahsan A; Department of Medicine, Foundation University Medical College, Islamabad, Pakistan., Fatima L; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Basit J; Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan.; Cardiovascular Analytics Group, Canterbury, UK., Nashwan AJ; Hamad Medical Corporation, Doha, Qatar., Ali S; Louisiana State University, Shreveport, LA, USA., Hamza M; Guthrie Medical Group, Cortland, NY, USA., Karalis I; Royal Brompton Hospital, London, UK., Ahmed R; Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Alareed A; Division of Neurophysiology, University Hospital Southampton (UHS), Southampton, UK., Ijioma NN; Ohio State University Wexner Medical Center, Columbus, OH, USA., Alraies MC; Wayne State University, Detroit, MI, USA.
Jazyk:	angličtina
Zdroj:	Vascular medicine (London, England) [Vasc Med] 2024 Oct; Vol. 29 (5), pp. 517-525. Date of Electronic Publication: 2024 Aug 20.
DOI:	10.1177/1358863X241265335
Abstrakt:	Background: Antiplatelet therapy plays an important role in reducing the risk of stroke recurrence in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA). However, data regarding the effectiveness and safety of using aspirin plus clopidogrel in dual antiplatelet therapy (DAPT) compared to aspirin alone in mild ischemic stroke is limited. Methods: PubMed/MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared DAPT to aspirin alone started within 72 hours in mild ischemic stroke or high-risk TIA. We used a random effects model to pool risk ratios (RRs) along with 95% CIs for clinical outcomes. Results: Four RCTs with 16,547 patients were included in this study. DAPT significantly reduced the risk of recurrent stroke by 26% (RR: 0.74; 95% CI: 0.67-0.83; p < 0.00001), ischemic stroke by 28% (RR: 0.72; 95% CI: 0.65-0.80; p < 0.00001), and major adverse cardiovascular events (MACE) by 24% (RR: 0.76; 95% CI: 0.68-0.84; p < 0.00001) compared to aspirin monotherapy. However, DAPT was associated with a significantly increased risk of moderate or severe bleeding (RR: 1.88; 95% CI: 1.10-3.23; p = 0.02) compared to aspirin alone. No significant differences were observed for hemorrhagic stroke (RR: 1.77; 95% CI: 0.96-3.29; p = 0.07), all-cause mortality (RR: 1.25; 95% CI: 0.87-1.80; p = 0.23), cardiovascular mortality (RR: 1.38; 95% CI: 0.81-2.33; p = 0.23), and myocardial infarction (RR: 1.63; 95% CI: 0.77-3.46; p = 0.20). Conclusion: DAPT involving aspirin plus clopidogrel reduces stroke recurrence and MACE but can lead to an increased risk of moderate or severe bleeding compared to aspirin monotherapy. (PROSPERO ID: CRD42024499310) . Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu