Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
August 14, 2023BMC NeurologyOpen Access

Ticagrelor plus aspirin in patients with minor ischemic stroke and transient ischemic attack: a network meta-analysis

View Full Paper
Ask AI
Bookmark
Share

Why the study?

Clopidogrel responsiveness is impaired by CYP2C19 genetic polymorphisms, and it remained unclear whether ticagrelor was superior to clopidogrel in ischemic stroke.

Does ticagrelor-based therapy reduce stroke recurrence compared to clopidogrel-based therapy or aspirin alone in patients with minor ischemic stroke or TIA?

Comparison

Ticagrelor, clopidogrel, and aspirin regimens

Design

Network meta-analysis of RCTs

Authors

MLMingxia LiYanbian UniversityQYQianru YangDongzhimen Hospital Affiliated to Beijing University of Chinese MedicineJSJiankuan ShiMedical Center Hospital

Discussion

Loading...

Member takes

Implication

Either DAPT regimen may be used interchangeably; extends evidence for ticagrelor in Asian patients with CYP2C19 variants.

Structured PICO

Does ticagrelor-based therapy reduce stroke recurrence compared to clopidogrel-based therapy or aspirin alone in patients with minor ischemic stroke or TIA?

P
Population
41,745 participants from 7 RCTs with minor ischemic stroke (NIHSS ≤ 5) or transient ischemic attack (ABCD2 ≥ 4), mean age 65 years.
I
Intervention
Dual antiplatelet therapy (ticagrelor plus aspirin or clopidogrel plus aspirin) or ticagrelor monotherapy initiated within 48 hours of index event.
C
Comparator
Aspirin monotherapy or alternative dual antiplatelet therapy regimen.
O
Outcome
Stroke recurrence, ischemic stroke recurrence, and major hemorrhage.hard clinical

In patients with minor ischemic stroke or TIA, dual antiplatelet therapy with either ticagrelor or clopidogrel is superior to aspirin alone for stroke prevention, with no significant efficacy difference between the two DAPT regimens, though ticagrelor may increase the risk of any bleeding.

Limitations

  • Varied study sample, treatment, and follow-up duration across included trials.
  • Only one trial (CHANCE-2) specifically enrolled CYP2C19 Loss-of-Function Carriers.
  • Small number of studies (7 RCTs) limits funnel plot evaluation and may cause potential publication bias.
  • Different criteria for endpoint events and study designs were adopted across trials.

Cite This Study

Li et al. (2023) studied this question.

synapsesocial.com/papers/6a708d9a26a7f98052dd0970https://doi.org/10.1186/s12883-023-03356-7

Topics

Dual antiplatelet therapy
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA2021 · 413 citations
  2. 2Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial2019 · 145 citations
  3. 3Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA2020 · 626 citations
  4. 4Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack2013 · 1,880 citations
  5. 5Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack2016 · 379 citations