Kirtipal Bhatia1, Vardhmaan Jain2, Devika Aggarwal3, Muthiah Vaduganathan4, Sameer Arora5, Zeeshan Hussain, Guneesh Uberoi6, Alfonso Tafur7, Cen Zhang8, Mark Ricciardi7, Arman Qamar7. 1. Department of Medicine, Icahn School of Medicine at Mount Sinai, NY (K.B.). 2. Department of Medicine, Cleveland Clinic, Cleveland, OH (V.J.). 3. Department of Medicine, Beaumont Hospital, Royal Oak, MI (D.A.). 4. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.V.). 5. Cardiovascular Division, University of North Carolina School of Medicine, Chapel Hill (S.A.). 6. Division of Cardiology, Loyola University School of Medicine, Maywood, IL. Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.U.). 7. Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health System, Evanston, IL (A.T., M.R., A.Q.). 8. Department of Neurology, New York University Grossman School of Medicine (C.Z.).
Abstract
Background and Purpose: Antiplatelet therapy is key for preventing thrombotic events after transient ischemic attack or ischemic stroke. Although the role of aspirin is well established, there is emerging evidence for the role of short-term dual antiplatelet therapy (DAPT) in preventing recurrent stroke. Methods: We conducted a systematic review and study-level meta-analyses of randomized controlled trials comparing outcomes of early initiation of short-term DAPT (aspirin+P2Y12 inhibitor for up to 3 months) versus aspirin alone in patients with acute stroke or transient ischemic attack. Primary efficacy outcome was risk of recurrent stroke and primary safety outcome was incidence of major bleeding. Secondary outcomes studied were risk of any ischemic stroke, hemorrhagic stroke, major adverse cardiovascular events, and all-cause death. Pooled risk ratios (RRs) and CIs were calculated using a random-effects model. Results: Four trials with a total of 21 459 patients were included. As compared to aspirin alone, DAPT had a lower risk of recurrent stroke (RR, 0.76 [95% CI, 0.68–0.83]; P<0.001; I2=0%) but a higher risk of major bleeding events (RR, 2.22 [95% CI, 1.14–4.34], P=0.02, I2=46.5%). Patients receiving DAPT had a lower risk of major adverse cardiovascular events (RR, 0.76 [95% CI, 0.69–0.84], P<0.001, I2=0%) and recurrent ischemic events (RR, 0.74 [95% CI, 0.67–0.82], P<0.001, I2=0%). Conclusions: As compared to aspirin alone, short-term DAPT within 24 hours of high-risk transient ischemic attack or mild-moderate ischemic stroke reduces the risk of recurrent stroke at the expense of higher risk of major bleeding.
Background and Purpose: Antiplatelet therapy is key for preventing thrombotic events after transient ischemic attack or ischemic stroke. Although the role of aspirin is well established, there is emerging evidence for the role of short-term dual antiplatelet therapy (DAPT) in preventing recurrent stroke. Methods: We conducted a systematic review and study-level meta-analyses of randomized controlled trials comparing outcomes of early initiation of short-term DAPT (aspirin+P2Y12 inhibitor for up to 3 months) versus aspirin alone in patients with acute stroke or transient ischemic attack. Primary efficacy outcome was risk of recurrent stroke and primary safety outcome was incidence of major bleeding. Secondary outcomes studied were risk of any ischemic stroke, hemorrhagic stroke, major adverse cardiovascular events, and all-cause death. Pooled risk ratios (RRs) and CIs were calculated using a random-effects model. Results: Four trials with a total of 21 459 patients were included. As compared to aspirin alone, DAPT had a lower risk of recurrent stroke (RR, 0.76 [95% CI, 0.68–0.83]; P<0.001; I2=0%) but a higher risk of major bleeding events (RR, 2.22 [95% CI, 1.14–4.34], P=0.02, I2=46.5%). Patients receiving DAPT had a lower risk of major adverse cardiovascular events (RR, 0.76 [95% CI, 0.69–0.84], P<0.001, I2=0%) and recurrent ischemic events (RR, 0.74 [95% CI, 0.67–0.82], P<0.001, I2=0%). Conclusions: As compared to aspirin alone, short-term DAPT within 24 hours of high-risk transient ischemic attack or mild-moderate ischemic stroke reduces the risk of recurrent stroke at the expense of higher risk of major bleeding.
Authors: Abdullah M Al Alawi; Ikhlas Al Busaidi; Emaad Al Shibli; Al-Reem Al-Senaidi; Shahd Al Manwari; Ibtisam Al Busaidi; Fatema Muhanna; Ahmed Al Qassabi Journal: Ann Saudi Med Date: 2022-08-04 Impact factor: 1.707