Key result
Ticagrelor plus aspirin for 21 days reduced recurrent ischemic stroke compared with aspirin monotherapy (OR 0.55; 95% CrI 0.46-0.66) but increased major bleeding.
Why the study?
Multiple DAPT regimens varying in drug combination and treatment duration are available for acute minor ischemic stroke or high-risk TIA, but their comparative efficacy and safety profiles have not been fully elucidated.
Do different dual antiplatelet therapy strategies (varying by drug and duration) reduce recurrent ischemic stroke compared to aspirin monotherapy in adults with acute minor ischemic stroke or high-risk TIA?
Comparison
Aspirin monotherapy, clopidogrel plus aspirin (21 or 90 days), ticagrelor plus aspirin (21 or 30 days), and ticagrelor monotherapy
Design
Systematic review and Bayesian random-effects network meta-analysis of randomized controlled trials
Follow-up
90 days
Authors
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May guide DAPT selection after minor stroke; leaves open optimal regimen and duration.
Meta-Analysis (n=50,349)
Do different dual antiplatelet therapy strategies (varying by drug and duration) reduce recurrent ischemic stroke compared to aspirin monotherapy in adults with acute minor ischemic stroke or high-risk TIA?
Odds Ratio: 0.55 (95% CI 0.46–0.66)
Clopidogrel plus aspirin for 21 days provides the most favorable net clinical benefit for secondary prevention after acute minor ischemic stroke or high-risk TIA, balancing ischemic protection and bleeding risk.
Zou et al. (2026) conducted a meta-analysis in acute minor ischemic stroke or high-risk transient ischemic attack (n=50,349). Ticagrelor plus aspirin vs. Aspirin monotherapy was evaluated on recurrent ischemic stroke at 90 days (OR 0.55, 95% CI 0.46-0.66). Ticagrelor plus aspirin for 21 days reduced recurrent ischemic stroke compared with aspirin monotherapy (OR 0.55; 95% CrI 0.46-0.66) but increased major bleeding.
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