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April 30, 2021Circulation

Efficacy and Safety of Using Dual Versus Monotherapy Antiplatelet Agents in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

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Why the study?

Dual antiplatelet treatment with aspirin plus clopidogrel for a limited time is recommended after minor noncardioembolic stroke, prompting evaluation of its efficacy and safety versus monotherapy.

Does dual antiplatelet treatment reduce recurrent stroke and composite cardiovascular events compared with monotherapy in patients with prior stroke or transient ischemic attack?

Population

27 358 patients evaluated for secondary prevention of recurrent stroke or transient ischemic attack

Comparison

DAPT vs monotherapy

Design

Systematic review and meta-analysis of randomized controlled clinical trials

Authors

GTGabriela TrifanPGPhilip B. GorelickFTFernando D. Testai

Discussion

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Overview

Short-term DAPT reduces recurrent stroke/TIA risk versus monotherapy; reinforces guidelines for minor noncardioembolic stroke.

Structured PICO

Does dual antiplatelet treatment reduce recurrent stroke and composite cardiovascular events compared with monotherapy in patients with prior stroke or transient ischemic attack?

P
Population
27,358 patients for the secondary prevention of recurrent stroke or transient ischemic attack
I
Intervention
Dual antiplatelet treatment (DAPT)
C
Comparator
Monotherapy antiplatelet agent
O
Outcome
Stroke and the composite of stroke, transient ischemic attack, acute coronary syndrome, and death from any causecomposite

DAPT is more effective than monotherapy for secondary stroke prevention but increases major bleeding, a risk that may be mitigated by limiting duration to ≤30 days and avoiding the combination of aspirin plus ticagrelor.

Cite This Study

Trifan et al. (2021) studied this question.

synapsesocial.com/papers/6a75662196d04a2f43f596behttps://doi.org/10.1161/circulationaha.121.053782
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Also Consider

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

  1. 1Comparative efficacy of clopidogrel-aspirin combination therapy versus aspirin monotherapy in preventing recurrent events in transient ischemic attack and minor stroke: a systematic review and meta-analysis2025 · 1 citations
  2. 2Efficacy and safety of dual versus mono antiplatelet therapy in patients with stroke or transient ischemic attack: An updated meta-analysis of 18 randomized controlled trials2020
  3. 3P2Y12 Inhibitors Plus Aspirin Versus Aspirin Alone in Patients With Minor Stroke or High-Risk Transient Ischemic Attack2021 · 19 citations
  4. 4Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials2021 · 90 citations
  5. 5Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials2024 · 18 citations