What question did this study set out to answer?

The study aims to evaluate the comparative efficacy and safety of long-term antiplatelet therapies after ischemic events.

August 25, 2015Journal of the American Heart AssociationOpen Access

Long‐Term Antiplatelet Mono‐ and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta‐Analysis

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Why the study?

Does long-term antiplatelet monotherapy or dual therapy reduce stroke recurrence in patients with ischemic stroke or transient ischemic attack?

Key Points

The study aims to evaluate the comparative efficacy and safety of long-term antiplatelet therapies after ischemic events.
Conducted a network meta-analysis of randomized controlled trials.
Included 24 trials with 85,667 patients receiving antiplatelet treatments for at least one year.
Compared 11 different antiplatelet therapies.
Cilostazol significantly reduced stroke recurrence compared to aspirin (OR 0.66, 95% CI 0.44 to 0.92) and dipyridamole (OR 0.57, 95% CI 0.34 to 0.95).
Cilostazol also reduced intracranial hemorrhage compared to multiple antiplatelet treatments.
Aspirin plus clopidogrel did not significantly reduce stroke recurrence compared to monotherapies but resulted in more major bleeding.

Structured PICO

Does long-term antiplatelet monotherapy or dual therapy reduce stroke recurrence in patients with ischemic stroke or transient ischemic attack?

Population

85,667 patients with ischemic stroke or transient ischemic attack from 24 randomized controlled trials

Intervention

Long-term antiplatelet therapies (11 different therapies including mono- and dual therapies) for at least 1 year

Comparator

Network meta-analysis comparing 11 antiplatelet therapies (including aspirin, dipyridamole, clopidogrel, cilostazol, terutroban, ticlopidine, aspirin plus clopidogrel, and aspirin plus dipyridamole)

Outcome

Stroke recurrencehard clinical

Long-term antiplatelet monotherapy, particularly cilostazol, offers a better risk-benefit profile than dual therapy for secondary prevention after ischemic stroke or transient ischemic attack.

Limitations

Need for more randomized controlled trials in non-East Asian patients to determine if cilostazol is the best option

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Cilostazol may warrant priority for long-term secondary stroke prevention; extends RCT network to refine antiplatelet selection beyond direct trials.

Cite This Study

Xie et al. (2015) studied this question.

synapsesocial.com/papers/6a70ab9fa528af2d65c3abbf https://doi.org/10.1161/jaha.115.002259

Topics

Dual antiplatelet therapy

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Implication

Cilostazol may warrant priority for long-term secondary stroke prevention; extends RCT network to refine antiplatelet selection beyond direct trials.

Long‐Term Antiplatelet Mono‐ and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta‐Analysis

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Long‐Term Antiplatelet Mono‐ and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta‐Analysis

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

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