Key result
DAPT for ≤90 days cuts recurrent ischemic stroke ~32% vs. SAPT without increasing major bleeding.
Why the study?
DAPT after ischemic stroke or transient ischemic attack may reduce recurrent stroke but increase severe bleeding compared with SAPT, prompting a systematic review to evaluate benefits and risks.
Does dual antiplatelet therapy reduce recurrent ischemic stroke compared to single antiplatelet therapy in patients with prior stroke or transient ischemic attack?
Population
Patients with ischemic stroke or transient ischemic attack across 5 phase III or IV RCTs
Comparison
DAPT vs SAPT
Design
Systematic review and meta-analysis of phase III or IV randomized controlled trials
Authors
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Short-duration DAPT safely cuts recurrent ischemic stroke risk after minor stroke/TIA; confirms benefit for early secondary prevention in RCTs.
Meta-Analysis
Does dual antiplatelet therapy reduce recurrent ischemic stroke compared to single antiplatelet therapy in patients with prior stroke or transient ischemic attack?
Effect estimate: RR 0.68 (95% CI 0.55-0.83)
Short-duration DAPT (≤90 days) is effective and safe for secondary stroke prevention early after minor stroke or high-risk TIA, but long-duration DAPT increases bleeding without significant benefit.
Brown et al. (2021) conducted a meta-analysis in Ischemic stroke or transient ischemic attack. Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) was evaluated on Recurrent ischemic stroke (short-duration trials) (RR 0.68, 95% CI 0.55-0.83). Dual antiplatelet therapy for ≤90 days reduced recurrent ischemic stroke compared with single antiplatelet therapy (RR 0.68; 95% CI 0.55–0.83) without significantly increasing major bleeding.
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