Key result
Dual therapy with clopidogrel and aspirin significantly reduced the overall incidence of stroke compared to aspirin alone (RR 0.77), though it was associated with a higher risk of bleeding.
Why the study?
Does dual therapy with clopidogrel and aspirin reduce stroke incidence in patients with previous stroke, TIA, or high risk of stroke compared to aspirin alone?
Meta-Analysis (n=24,084)
Double-blind (mostly)
Randomized
Yes
Does dual therapy with clopidogrel and aspirin reduce stroke incidence in patients with previous stroke, TIA, or high risk of stroke compared to aspirin alone?
Dual antiplatelet therapy with clopidogrel and aspirin significantly reduces stroke incidence compared to aspirin alone in patients with prior stroke, TIA, or high risk, but is associated with an increased risk of bleeding.
Answers are grounded in this paper and cite their sources.
Clinicians should weigh stroke benefit against bleeding when considering dual therapy; confirms prior trial results in meta-analysis.
BACKGROUND AND PURPOSE: Antiplatelet therapy is widely used for the primary or secondary prevention of stroke. Drugs like clopidogrel have emerged as alternatives for traditional antiplatelet therapy, and dual therapy with clopidogrel and aspirin is of particular interest. We conducted this meta-analysis to systematically review studies about dual therapy comparing monotherapy with aspirin alone. METHODS: Randomized controlled trials were searched in PubMed (1966-May, 2015), EMBASE (1947-May, 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (1948-May, 2015), WHO International Clinical Trial (ICTRP) (2004-May, 2015), China Biology Medicine disc (CBM disc) (1978-May, 2015) and were included into the final analysis according to the definite inclusion criteria mentioned in the study selection section. Risk ratio (RR) was pooled with 95% confidence interval (CI) for dichotomous data. The heterogeneity was considered significant if the χ2 test was significant (P value < 0.10) or the I2 > 50.00%. Subgroup analyses were carried out on the long and short time periods, the race and region. RESULTS: We included 5 studies involving 24,084 patients. A pooled analysis showed that dual therapy with clopidogrel and aspirin had a lower stroke incidence than monotherapy in both the short term and long term (RR = 0.69, 95% CI: 0.59-0.82, P <0.05; RR = 0.84, 95% CI: 0.72-0.98, P = 0.03, respectively). With regard to safety, dual therapy had a higher risk of bleeding than monotherapy for both periods (RR = 1.51, 95% CI: 1.03-2.23, P = 0.04; RR = 1.54, 95% CI: 1.32-1.79, P<0.05, respectively). CONCLUSIONS: Dual therapy with clopidogrel and aspirin could be a preferable choice to prevent stroke in patients who have had a previous stroke or transient ischemic attack, as well as those who are at high risk for stroke. And the effect of dual therapy seems to be more obvious for short-term. However, it is associated with a higher risk of bleeding.
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Tan et al. (2015) conducted a meta-analysis in Stroke prevention (n=24,084). Clopidogrel and Aspirin vs. Aspirin alone was evaluated on Stroke incidence (RR 0.77, 95% CI 0.69-0.86, p=<0.05). Dual therapy with clopidogrel and aspirin significantly reduced the overall incidence of stroke compared to aspirin alone (RR 0.77), though it was associated with a higher risk of bleeding.
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