Key result
Dual antiplatelet therapy significantly reduced ischemic stroke recurrence compared to mono-antiplatelet therapy in patients with symptomatic large artery atherosclerosis, with an absolute risk reduction of 3%.
Why the study?
The efficacy and safety of DAPT in ischemic stroke patients with large artery atherosclerosis remained uncertain, despite established evidence across broader non-cardioembolic stroke populations.
Does dual antiplatelet therapy reduce ischemic stroke recurrence in patients with acute ischemic stroke or TIA and large artery atherosclerosis compared to mono-antiplatelet therapy?
Meta-Analysis (n=5,004)
Does dual antiplatelet therapy reduce ischemic stroke recurrence in patients with acute ischemic stroke or TIA and large artery atherosclerosis compared to mono-antiplatelet therapy?
Absolute Risk Reduction: 3 (95% CI 0–5)
Absolute Event Rate: 5.99% vs 9.55%
Absolute Risk Reduction: 3%
Number Needed to Treat: 33
p-value: p=0.002
In patients with acute ischemic stroke or TIA and large artery atherosclerosis, DAPT reduces the risk of recurrent ischemic stroke without increasing major bleeding compared to MAPT.
Supports short-term DAPT in symptomatic LAA stroke; extends broad non-cardioembolic evidence to this high-risk etiology.
Background and purpose Current pieces of evidence support the short-term use of dual antiplatelet (DAPT) in minor ischemic stroke or transient ischemic attack (TIA) based on the studies performed in patients with a broad range of non-cardioembolic stroke mechanisms. However, the efficacy and safety of DAPT use in ischemic stroke patients with large artery atherosclerosis (LAA) are still uncertain. We undertook a systemic search and formal meta-analysis to compare DAPT vs. mono-antiplatelet therapy (MAPT) in patients with etiology specifically presumed to be symptomatic LAA. Methods We conducted a systemic online search for completed randomized controlled trials that (1) compared DAPT vs. MAPT in patients with acute ischemic stroke or TIA, and (2) were confined to or had available subgroup data regarding population with symptomatic extra- or intracranial artery stenosis. Study-level meta-analysis was performed for outcomes, including ischemic stroke (IS) recurrence, intracranial hemorrhage (ICH), and major bleeding with the Mantel-Haenszel method and random effect models, and was described as risk difference (RD) and 95% CI. Results A total of 10 trials including 5,004 patients were pooled. Comparing to MAPT, DAPT significantly reduced IS recurrence (5.99 vs. 9.55%, RD: −3%, 95% CI: −5 – 0%). Across all agents, out of 100 treated patients, 3 fewer had a recurrent ischemic stroke with DAPT. The safety endpoints including ICH (0.28 vs. 0.32%, RD: 0%, 95% CI: −0 – 0%) and major bleeding (0.73 vs. 0.51%, RD: 0%, 95% CI: −0 – 0%) did not differ significantly. Conclusion In patients with symptomatic large artery extracranial or intracranial atherosclerosis, DAPT was superior to MAPT in preventing IS recurrence without increasing bleeding risks. The optimal DAPT regimens and duration of treatment in this population need to be clarified in further studies.
No takes yet. Share an insight, caveat, or question.
Lin et al. (2022) conducted a meta-analysis in Acute ischemic stroke or transient ischemic attack with large artery atherosclerosis (n=5,004). Dual antiplatelet therapy vs. Mono-antiplatelet therapy was evaluated on Ischemic stroke recurrence (RD -3%, 95% CI -5 to 0, p=0.002). Dual antiplatelet therapy significantly reduced ischemic stroke recurrence compared to mono-antiplatelet therapy in patients with symptomatic large artery atherosclerosis, with an absolute risk reduction of 3%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: