Key result
P2Y12 inhibitors plus aspirin reduces stroke recurrence ~22% vs aspirin alone but increases all-cause mortality.
Why the study?
The efficacy and safety of P2Y12 inhibitors plus aspirin compared with aspirin alone in patients with non-cardioembolic ischemic cerebrovascular events remains debated.
Does the combination of P2Y12 inhibitors and aspirin reduce stroke recurrence, all-cause mortality, and severe bleeding in patients with non-cardioembolic ischemic cerebrovascular events compared to aspirin alone?
Meta-Analysis (n=38,851)
Does the combination of P2Y12 inhibitors and aspirin reduce stroke recurrence, all-cause mortality, and severe bleeding in patients with non-cardioembolic ischemic cerebrovascular events compared to aspirin alone?
Answers are grounded in this paper and cite their sources.
In patients with non-cardioembolic ischemic cerebrovascular events, dual antiplatelet therapy with a P2Y12 inhibitor and aspirin reduces stroke recurrence but comes at the cost of increased all-cause mortality and severe bleeding.
BACKGROUND: The efficacy and safety of P2Y12 inhibitors (P2Y12i) with aspirin in patients with non-cardioembolic ischemic cerebrovascular events remains a topic of ongoing debate. Therefore, we conducted an updated meta-analysis to compare these drugs with aspirin alone. METHODS: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing the two treatment regimens in patients with ischemic cerebrovascular events. Primary outcomes were all-cause mortality, severe bleeding, and stroke recurrence. We performed subgroup analyses stratified by National Institutes of Health Stroke Scale (NIHSS). Risk ratios (RRs) with 95 % confidence intervals were calculated using a random effects model. R software (version 4.3.2) was used for statistical analyses. RESULTS: Fifteen studies were included, comprising 38,851 patients, of whom 19,483 (50.1 %) received P2Y12i plus aspirin. Follow-up ranged from 7 days to 3.4 years. P2Y12i plus aspirin significantly reduced stroke recurrence (RR 0.78; 95 % CI = 0.71-0.87; p < 0.05), but increased the incidence of all-cause mortality (RR 1.38; 95 % CI = 1.11-1.72; p < 0.05) and severe bleeding (RR 2.07; 95 % CI 1.61 to 2.66; p > 0.05) compared with aspirin. There was no significant difference between groups in all-cause mortality in patients with NIHSS ≤3 or ≤10. CONCLUSION: P2Y12i plus aspirin reduced stroke recurrence, but increased all-cause mortality and severe bleeding in patients with non-cardioembolic ischemic events. There was no difference between groups in all-cause mortality in patients with NIHSS scores ≤3 or ≤10.
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Faria et al. (2025) conducted a meta-analysis in ischemic cerebrovascular events (n=38,851). P2Y12 inhibitors plus aspirin vs. aspirin alone was evaluated on all-cause mortality, severe bleeding, and stroke recurrence (RR 0.78, 95% CI 0.71-0.87, p=< 0.05). P2Y12 inhibitors plus aspirin reduced stroke recurrence but increased all-cause mortality compared to aspirin alone.
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