Why the study?
The comparative effectiveness of aspirin-clopidogrel dual antiplatelet therapy versus aspirin or clopidogrel monotherapy in ischemic stroke patients required evaluation.
Does aspirin-clopidogrel dual antiplatelet therapy reduce ischemic stroke recurrence, rehospitalization, and all-cause mortality compared to antiplatelet monotherapy in patients with ischemic stroke?
Does aspirin-clopidogrel dual antiplatelet therapy reduce ischemic stroke recurrence, rehospitalization, and all-cause mortality compared to antiplatelet monotherapy in patients with ischemic stroke?
In patients with ischemic stroke, dual antiplatelet therapy with aspirin and clopidogrel was not superior to monotherapy in reducing stroke recurrence or mortality, and was associated with higher rehospitalization for cardiovascular events.
DAPT not superior to monotherapy for recurrence or mortality; leaves open optimal antiplatelet strategy pending randomized data.
Objectives: To compare the effectiveness of aspirin-clopidogrel dual antiplatelet therapy (DAPT) with aspirin or clopidogrel antiplatelet monotherapy (AM) in patients with ischemic stroke. Methods: It was a single-center, retrospective cross-sectional study of medical records of ischemic stroke patients admitted at King Abdulaziz University Hospital between January 2015 and October 2019. The primary endpoints were ischemic stroke recurrence, rehospitalization, and all-cause mortality between DAPT and AM. Kaplan-Meier and Cox proportional hazard analyses were employed in univariate and multivariate time-to-event analyses. Results: The median time to recurrence of ischemic stroke was 15.0 months (95% confidence interval [CI], 8.586–23.01) for DAPT and 20.4 months (95% CI, 9.872–30.928) for the AM. The median survival time until all-cause mortality was 8.0 months (95% CI, 2.893–13.107) for DAPT and 14.1 months (95% CI, 8.173–19.97) for the AM. No statistically significant reductions in the instantaneous risks of recurrence (hazard ratio [HR], 1.27; 95% CI, 0.59–2.72; p=0.54), re-hospitalization (HR, 0.95; 95% CI, 0.59–1.48; p= 0.77), and mortality (HR, 1.04; 95% CI, 0.48–2.26; p=0.92) were found between the DAPT and AM groups. Conclusion: The DAPT was not superior to AM in reducing recurrence and mortality events in patients with ischemic stroke. Rehospitalization due to the sequelae of the composite of stroke, angina, and myocardial infarction was higher in the DAPT group.
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Algarni et al. (2023) studied this question.
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