Key result
Intensified antiplatelet regimens lower stroke recurrence over monotherapy but increase bleeding without improving mortality.
Why the study?
Stroke is a leading cause of death and disability worldwide, prompting the need for comprehensive insight into the effectiveness and safety of antiplatelet and anticoagulant regimens for secondary prevention after ischemic stroke or TIA.
Does antiplatelet or anticoagulant therapy reduce recurrent stroke in patients with non-cardioembolic ischemic stroke or transient ischemic attack?
Systematic Review
Does antiplatelet or anticoagulant therapy reduce recurrent stroke in patients with non-cardioembolic ischemic stroke or transient ischemic attack?
Intensified antiplatelet therapy reduces recurrent stroke but increases bleeding risk, highlighting the need for individualized bleeding risk assessment.
Supports individualized antiplatelet selection by bleeding risk; reinforces RCT synthesis on recurrence-bleeding trade-offs in non-cardioembolic stroke.
Stroke embodies one of the leading causes of death and disability worldwide. We aimed to provide a comprehensive insight into the effectiveness and safety of antiplatelet agents and anticoagulants in the secondary prevention of ischemic stroke or transient ischemic attack. A systematic search for randomized controlled trials, comparing antiplatelet or anticoagulant therapy versus aspirin or placebo among patients with ischemic stroke or transient ischemic attack, was performed in order to summarize data regarding the different regimens. Keyword-based searches in the MEDLINE, EMBASE, and Cochrane Library databases were conducted until the 1st of January 2021. Our search explored 46 randomized controlled trials involving ten antiplatelet agents, six combinations with aspirin, and four anticoagulant therapies. The review of the literature reflects that antiplatelet therapy improves outcome in patients with ischemic stroke or transient ischemic attack. Monotherapy proved to be an effective and safe choice, especially in patients with a high risk of bleeding. Intensified antiplatelet regimens further improve stroke recurrence; however, bleeding rate increases while mortality remains unaffected. Supplementing the clinical judgment of stroke treatment, assessment of bleeding risk is warranted to identify patients with the highest benefit of treatment intensification.
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Tornyos et al. (2021) conducted a systematic review in Non-cardioembolic ischemic stroke or transient ischemic attack. Antiplatelet and anticoagulant therapy vs. Aspirin or placebo was evaluated on Recurrent stroke and bleeding events. Antiplatelet monotherapy is effective and safe for secondary prevention, while intensified regimens further reduce stroke recurrence at the cost of increased bleeding risk without affecting mortality.
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