Key result
Short-term DAPT reduces recurrent stroke ~24% vs aspirin alone but increases major bleeding.
Why the study?
Although the role of aspirin is well established, there is emerging evidence for the role of short-term dual antiplatelet therapy in preventing recurrent stroke after transient ischemic attack or ischemic stroke.
Does early short-term DAPT reduce the risk of recurrent stroke compared to aspirin alone in patients with acute stroke or transient ischemic attack?
Population
21 459 patients across 4 RCTs with acute stroke or transient ischemic attack
Comparison
Early short-term DAPT (aspirin plus P2Y12 inhibitor for up to 3 months) vs aspirin alone
Design
Systematic review and study-level meta-analysis of randomized controlled trials
Authors
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Supports short-term DAPT in acute TIA/minor stroke to lower recurrence; reinforces Level 1 RCT meta-evidence despite bleeding trade-off.
Meta-Analysis (n=21,459)
Does early short-term DAPT reduce the risk of recurrent stroke compared to aspirin alone in patients with acute stroke or transient ischemic attack?
Effect estimate: RR 0.76 (95% CI 0.68-0.83)
p-value: p=<0.001
Short-term DAPT within 24 hours of high-risk TIA or mild-moderate ischemic stroke reduces recurrent stroke risk but increases major bleeding compared to aspirin alone.
Bhatia et al. (2021) conducted a meta-analysis in acute stroke or transient ischemic attack (n=21,459). short-term DAPT (aspirin+P2Y12 inhibitor) vs. aspirin alone was evaluated on risk of recurrent stroke (RR 0.76, 95% CI 0.68-0.83, p=<0.001). Short-term dual antiplatelet therapy reduced the risk of recurrent stroke compared to aspirin alone (RR 0.76; 95% CI 0.68-0.83; P<0.001), but increased the risk of major bleeding.
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