Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis
Background and purposeCurrent pieces of evidence support the short-term use of dual antiplatelet (DAPT) in minor ischemic stroke or transient ischemic attack (TIA) based on the studies performed in patients with a broad range of non-cardioembolic stroke mechanisms. However, the efficacy and safety o...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.923142/full |
| _version_ | 1798003128785698816 |
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| author | Chun-Jen Lin Chun-Jen Lin Tzu-Yun Tseng Jeffrey L. Saver |
| author_facet | Chun-Jen Lin Chun-Jen Lin Tzu-Yun Tseng Jeffrey L. Saver |
| author_sort | Chun-Jen Lin |
| collection | DOAJ |
| description | Background and purposeCurrent pieces of evidence support the short-term use of dual antiplatelet (DAPT) in minor ischemic stroke or transient ischemic attack (TIA) based on the studies performed in patients with a broad range of non-cardioembolic stroke mechanisms. However, the efficacy and safety of DAPT use in ischemic stroke patients with large artery atherosclerosis (LAA) are still uncertain. We undertook a systemic search and formal meta-analysis to compare DAPT vs. mono-antiplatelet therapy (MAPT) in patients with etiology specifically presumed to be symptomatic LAA.MethodsWe conducted a systemic online search for completed randomized controlled trials that (1) compared DAPT vs. MAPT in patients with acute ischemic stroke or TIA, and (2) were confined to or had available subgroup data regarding population with symptomatic extra- or intracranial artery stenosis. Study-level meta-analysis was performed for outcomes, including ischemic stroke (IS) recurrence, intracranial hemorrhage (ICH), and major bleeding with the Mantel-Haenszel method and random effect models, and was described as risk difference (RD) and 95% CI.ResultsA total of 10 trials including 5,004 patients were pooled. Comparing to MAPT, DAPT significantly reduced IS recurrence (5.99 vs. 9.55%, RD: −3%, 95% CI: −5–0%). Across all agents, out of 100 treated patients, 3 fewer had a recurrent ischemic stroke with DAPT. The safety endpoints including ICH (0.28 vs. 0.32%, RD: 0%, 95% CI: −0–0%) and major bleeding (0.73 vs. 0.51%, RD: 0%, 95% CI: −0–0%) did not differ significantly.ConclusionIn patients with symptomatic large artery extracranial or intracranial atherosclerosis, DAPT was superior to MAPT in preventing IS recurrence without increasing bleeding risks. The optimal DAPT regimens and duration of treatment in this population need to be clarified in further studies. |
| first_indexed | 2024-04-11T12:02:49Z |
| format | Article |
| id | doaj.art-621db474e88349ccafacf4c8c6e03af0 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T12:02:49Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-621db474e88349ccafacf4c8c6e03af02022-12-22T04:24:48ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-09-011310.3389/fneur.2022.923142923142Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosisChun-Jen Lin0Chun-Jen Lin1Tzu-Yun Tseng2Jeffrey L. Saver3Neurological Institute, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, TaiwanComprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesBackground and purposeCurrent pieces of evidence support the short-term use of dual antiplatelet (DAPT) in minor ischemic stroke or transient ischemic attack (TIA) based on the studies performed in patients with a broad range of non-cardioembolic stroke mechanisms. However, the efficacy and safety of DAPT use in ischemic stroke patients with large artery atherosclerosis (LAA) are still uncertain. We undertook a systemic search and formal meta-analysis to compare DAPT vs. mono-antiplatelet therapy (MAPT) in patients with etiology specifically presumed to be symptomatic LAA.MethodsWe conducted a systemic online search for completed randomized controlled trials that (1) compared DAPT vs. MAPT in patients with acute ischemic stroke or TIA, and (2) were confined to or had available subgroup data regarding population with symptomatic extra- or intracranial artery stenosis. Study-level meta-analysis was performed for outcomes, including ischemic stroke (IS) recurrence, intracranial hemorrhage (ICH), and major bleeding with the Mantel-Haenszel method and random effect models, and was described as risk difference (RD) and 95% CI.ResultsA total of 10 trials including 5,004 patients were pooled. Comparing to MAPT, DAPT significantly reduced IS recurrence (5.99 vs. 9.55%, RD: −3%, 95% CI: −5–0%). Across all agents, out of 100 treated patients, 3 fewer had a recurrent ischemic stroke with DAPT. The safety endpoints including ICH (0.28 vs. 0.32%, RD: 0%, 95% CI: −0–0%) and major bleeding (0.73 vs. 0.51%, RD: 0%, 95% CI: −0–0%) did not differ significantly.ConclusionIn patients with symptomatic large artery extracranial or intracranial atherosclerosis, DAPT was superior to MAPT in preventing IS recurrence without increasing bleeding risks. The optimal DAPT regimens and duration of treatment in this population need to be clarified in further studies.https://www.frontiersin.org/articles/10.3389/fneur.2022.923142/fulldual antiplatelet therapylarge artery atherosclerosis (LAA)ischemic strokemeta-analysisclopidogrelcilostazol |
| spellingShingle | Chun-Jen Lin Chun-Jen Lin Tzu-Yun Tseng Jeffrey L. Saver Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis Frontiers in Neurology dual antiplatelet therapy large artery atherosclerosis (LAA) ischemic stroke meta-analysis clopidogrel cilostazol |
| title | Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| title_full | Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| title_fullStr | Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| title_full_unstemmed | Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| title_short | Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| title_sort | dual vs mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis |
| topic | dual antiplatelet therapy large artery atherosclerosis (LAA) ischemic stroke meta-analysis clopidogrel cilostazol |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.923142/full |
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