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May 27, 2021Stroke

DAPT reduces recurrent stroke ~24% versus aspirin alone in minor stroke or high-risk TIA.

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Why the study?

The study was conducted to elucidate the effectiveness and safety of DAPT with P2Y12 inhibitors (clopidogrel/ticagrelor) and aspirin versus aspirin monotherapy in patients with mild ischemic stroke or high-risk transient ischemic attack.

Does dual antiplatelet therapy with P2Y12 inhibitors and aspirin reduce subsequent stroke in patients with mild ischemic stroke or high-risk TIA compared to aspirin alone?

Population

21 493 participants with acute mild ischemic stroke or high-risk transient ischemic attack across 4 trials

Comparison

DAPT with clopidogrel/ticagrelor and aspirin vs aspirin alone

Design

Systematic review and meta-analysis of randomized controlled trials

Key result

DAPT with aspirin and a P2Y12 inhibitor reduced the risk of stroke recurrence by 24% (RR 0.76; 95% CI 0.68-0.83) compared to aspirin alone in patients with minor stroke or high-risk TIA.

Authors

ZLZixiao LiVascular / Pulmonary VascularYXYunyun XiongBeijing Tian Tan HospitalHGHongqiu GuUniversity Health Network

Discussion

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Overview

Supports early DAPT in minor stroke or high-risk TIA; confirms Level 1 meta-analytic evidence despite bleeding increase.

Study Design

Type

Meta-Analysis (n=21,493)

Structured PICO

Does dual antiplatelet therapy with P2Y12 inhibitors and aspirin reduce subsequent stroke in patients with mild ischemic stroke or high-risk TIA compared to aspirin alone?

P
Population
21,493 patients with acute mild ischemic stroke or high-risk transient ischemic attack (pooled from 4 RCTs)
I
Intervention
Dual antiplatelet therapy (DAPT) with P2Y12 inhibitors (clopidogrel or ticagrelor) and aspirin started within 24 hours of symptom onset
C
Comparator
Aspirin monotherapy
O
Outcome
Subsequent strokehard clinical

Main Result

Effect estimate: RR 0.76 (95% CI 0.68-0.83)

In patients with mild stroke or high-risk TIA, DAPT with aspirin and clopidogrel/ticagrelor reduces recurrent stroke risk compared to aspirin alone, though with a small absolute increase in severe or moderate bleeding.

Cite This Study

Li et al. (2021) conducted a meta-analysis in mild ischemic stroke or high-risk transient ischemic attack (n=21,493). Dual antiplatelet therapy (DAPT) with P2Y12 inhibitors (clopidogrel/ticagrelor) and aspirin vs. Aspirin alone was evaluated on Stroke recurrence (RR 0.76, 95% CI 0.68-0.83). DAPT with aspirin and a P2Y12 inhibitor reduced the risk of stroke recurrence by 24% (RR 0.76; 95% CI 0.68-0.83) compared to aspirin alone in patients with minor stroke or high-risk TIA.

synapsesocial.com/papers/6a0e4e0fbc348c84f2fd9a07https://doi.org/10.1161/strokeaha.120.033040
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials2024 · 18 citations
  2. 2Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials2021 · 90 citations
  3. 3Comparative efficacy of clopidogrel-aspirin combination therapy versus aspirin monotherapy in preventing recurrent events in transient ischemic attack and minor stroke: a systematic review and meta-analysis2025 · 1 citations
  4. 4Randomised controlled trials of dual antiplatelet therapy versus aspirin in patients with stroke or transient ischaemic attack: an updated meta-analysis2025
  5. 5Efficacy and Safety of Using Dual Versus Monotherapy Antiplatelet Agents in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials2021 · 37 citations