Key result
Long-term dual antiplatelet therapy in patients with ischemic stroke has not proven advantageous due to bleeding risks, though shorter-term therapy after TIA appears efficacious and safe.
Why the study?
Does dual antiplatelet therapy improve outcomes compared to single antiplatelet therapy in patients with ischemic stroke?
Does dual antiplatelet therapy improve outcomes compared to single antiplatelet therapy in patients with ischemic stroke?
This commentary discusses a meta-analysis evaluating the net risks and benefits of long-term dual versus single antiplatelet therapy in patients with ischemic stroke.
Commentary on: Lee M, Saver JL, Hong KS, et al. Risk-benefit profile of long-term dual-versus single-antiplatelet therapy among patients with ischemic stroke: a systematic review and meta-analysis. Ann Intern Med 2013;159:463–70.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Dual antiplatelet therapy (DAT) has yet to prove advantageous when taking into account the net risks and benefits of longer term administration. The primary drawback is the risk of bleeding complications, including intracranial haemorrhage and gastrointestinal bleeding.1 ,2 However, shorter term combination therapy after transient ischaemic attack (TIA) has been shown to be efficacious and safe.3 ,4 This study assessed seven randomised controlled trials, comprising 39 574 patients and comparing dual versus single antiplatelet therapies. Medications used included aspirin (50–325 mg daily), clopidogrel (75 mg daily), aspirin plus dipyridamole (50/400 mg daily) … [1]: {openurl}?query=rft.jtitle%253DAnn%2BIntern%2BMed%26rft.volume%253D159%26rft.spage%253D463%26rft_id%253Dinfo%253Adoi%252F10.7326%252F0003-4819-159-7-201310010-00006%26rft_id%253Dinfo%253Apmid%252F24081287%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.7326/0003-4819-159-7-201310010-00006&link_type=DOI [3]: /lookup/external-ref?access_num=24081287&link_type=MED&atom=%2Febmed%2F19%2F4%2F137.atom [4]: /lookup/external-ref?access_num=000325628000004&link_type=ISI
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Farooq et al. (2014) conducted a review in Ischemic stroke (n=39,574). Dual antiplatelet therapy vs. Single antiplatelet therapy was evaluated. Long-term dual antiplatelet therapy in patients with ischemic stroke has not proven advantageous due to bleeding risks, though shorter-term therapy after TIA appears efficacious and safe.
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