Key result
Oral anticoagulants were associated with a lower risk of recurrent ischemic stroke compared with antiplatelet therapies (RR 0.61; 95% CI 0.41-0.91; P=0.02).
Why the study?
The best antithrombotic strategy for cryptogenic stroke with potential cardiac emboli is not known.
Do oral anticoagulants reduce recurrent ischemic stroke in patients with cryptogenic stroke and potential cardiac emboli compared to antiplatelet therapies?
Meta-Analysis (n=2,282)
Do oral anticoagulants reduce recurrent ischemic stroke in patients with cryptogenic stroke and potential cardiac emboli compared to antiplatelet therapies?
Relative Risk: 0.61 (95% CI 0.41–0.91)
p-value: p=0.02
In patients with cryptogenic stroke and potential cardiac emboli, oral anticoagulants significantly reduce the risk of recurrent ischemic stroke compared to antiplatelet therapy.
Supports oral anticoagulants over antiplatelets for recurrent ischemic stroke prevention; strengthens meta-analytic evidence.
BACKGROUND: The best antithrombotic strategy for cryptogenic stroke with potential cardiac emboli is not known. The objective of this study was to conduct a meta-analysis to evaluate the efficacy and safety of oral anticoagulants (OACs) vs. antiplatelet therapies in these patients METHODS: Pubmed, EMBASE, CENTRAL and clinicaltrials.gov were searched from January 1980 to April 2021 to identify trials comparing OACs versus antiplatelet therapies in patients with cryptogenic stroke and potential cardiac emboli (patent foramen ovale, moderate-severe left atrial enlargement, heart failure with reduced ejection fraction). Relative risk (RR) with 95% confidence (CI) was used as a measure of the effect of OACs versus antiplatelet therapies on recurrent ischemic stroke and major bleeding. We computed a random-effect estimate based on the Mantel-Haenszel method for a given outcome. RESULTS: We identified 6 studies derived from 5 trials with 2282 patients. Pooled results from 6 studies showed that compared with antiplatelet therapies, OACs were associated with a lower risk of recurrent ischemic stroke (RR 0.61, 95% CI 0.41 to 0.91, P=0.02). Only 3 studies of cryptogenic stroke with patent foramen ovale reported a major bleeding endpoint and pooled results from random-effects model showed that OACs compared with antiplatelet therapies were associated with a non-significantly increased risk of major bleeding (RR 1.61, 95% CI 0.76 to 3.40, P=0.21). CONCLUSIONS: OACs compared with antiplatelet therapies were associated with a reduced recurrent ischemic stroke risk and OACs might be a viable non-procedural alternative in patients with cryptogenic stroke and potential cardiac emboli.
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Huang et al. (2021) conducted a meta-analysis in Cryptogenic stroke with potential cardiac emboli (n=2,282). Oral anticoagulants (OACs) vs. Antiplatelet therapies was evaluated on Recurrent ischemic stroke (RR 0.61, 95% CI 0.41 to 0.91, p=0.02). Oral anticoagulants were associated with a lower risk of recurrent ischemic stroke compared with antiplatelet therapies (RR 0.61; 95% CI 0.41-0.91; P=0.02).
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