Optimization and individualization of dual antiplatelet therapy strategies for older patients with mild to moderate ischemic stroke: a meta-analysis

Although many interventions have been proposed to reduce morbidity and mortality following a transient ischemic attack or ischemic stroke, the optimal procedure is controversial. Since dual antiplatelet therapy with clopidogrel and aspirin and aspirin alone are widely used for people who have experienced a transient ischemic attack or an ischemic stroke, we sought to identify the benefits and risks of each intervention to provide healthcare provider with objective evidence for use in construct comprehensive treatment plans. We conducted a systematic review and meta-analysis to assess dual antiplatelet therapy vs . monotherapy for stroke prevention after mild to moderate ischemic strokes utilizing randomized controlled trials from PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane up to April 3, 2024, and mean difference for continuous outcomes and risk ratio (RR) for dichotomous outcomes, with 95% confidence intervals (CI). Seven randomized controlled trials with 20,992 patients were included. Dual antiplatelet therapy reduced combined ischemic and hemorrhagic stroke recurrence (RR = 0.77, 95% CI: 0.70, 0.84, P < 0.00001), ischemic strokes (RR = 0.74, 95% CI: 0.67, 0.82, P < 0.00001), poor functional outcome (RR = 0.89, 95% CI: 0.81, 0.98, P = 0.02), and early neurologic deterioration (RR = 0.46, 95% CI: 0.24, 0.88, P = 0.04), but increased bleeding events (RR = 1.74, 95% CI: 1.23, 2.48, P = 0.002). Both groups were comparable in hemorrhagic strokes, all-cause mortality, transient ischemic attack, and myocardial infarction. Taken together, dual antiplatelet therapy improves stroke prevention and functional outcomes but requires caution due to increased bleeding risk.