Key result
Aspirin monotherapy showed no significant difference in the risk of recurrent stroke compared to clopidogrel monotherapy (RR 0.79) for secondary prevention in patients with type 2 diabetes and previous ischemic stroke.
Why the study?
Aspirin is recommended for secondary prevention of recurrent ischemic stroke in T2DM, but clopidogrel is an alternative for aspirin intolerance, prompting a systematic comparison of the two monotherapies.
Does clopidogrel monotherapy reduce recurrent cerebrovascular attack compared to aspirin monotherapy in patients with T2DM and previous ischemic stroke?
Meta-Analysis (n=9,218)
Does clopidogrel monotherapy reduce recurrent cerebrovascular attack compared to aspirin monotherapy in patients with T2DM and previous ischemic stroke?
Relative Risk: 0.79 (95% CI 0.61–1.02)
p-value: p=0.07
Clopidogrel monotherapy is neither inferior nor superior to aspirin monotherapy for the secondary prevention of recurrent stroke in patients with T2DM, making it an equally safe and effective alternative.
Either agent is suitable for secondary stroke prevention in T2DM; confirms equivalence of aspirin and clopidogrel monotherapy.
INTRODUCTION: Type 2 diabetes mellitus (T2DM) and stroke are two different diseases, but have many aspects in common. Aspirin is recommended as an initial treatment for the secondary prevention of recurrent ischemic stroke in patients with T2DM. However, clopidogrel is an oral antiplatelet drug that might be another choice in case of aspirin intolerance. In this analysis, we aimed to systematically compare aspirin versus clopidogrel monotherapy for the secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke in patients with T2DM. METHODS: Online medical databases including Web of Science, MEDLINE, Cochrane central, EMBASE and http://www.ClinicalTrials.com were searched for published articles that satisfied the inclusion and exclusion criteria of this study. Recurrent stroke, fatal stroke, cerebral hemorrhage, myocardial infarction and mortality were considered the main end points in these patients with T2DM. RevMan 5.3 software was used to statistically analyze the data representing each subgroup. Risk ratios (RRs) with 95% confidence intervals (CIs) were used to represent the results following analysis. RESULTS: A total of 9218 participants with T2DM who were previously affected by ischemic stroke were included in this analysis, whereby 4917 were assigned to aspirin and 4301 to clopidogrel. This current analysis showed that there was no significant difference in recurrent stroke rate (RR: 0.79, 95% CI: 0.61-1.02; P = 0.07) observed with aspirin versus clopidogrel in these patients with T2DM. The risk of fatal stroke (RR: 0.88, 95% CI: 0.39-1.98; P = 0.76), cerebral hemorrhage (RR: 0.65, 95% CI: 0.38-1.11; P = 0.12), myocardial infarction (RR: 0.88, 95% CI: 0.43-1.79; P = 0.71) and mortality (RR: 1.07, 95% CI: 0.90-1.27; P = 0.44) were also similarly manifested. CONCLUSION: Clopidogrel monotherapy was neither inferior nor superior to aspirin monotherapy for the secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke in patients with T2DM. Hence, clopidogrel or aspirin monotherapy is equally safe and effective in these patients with T2DM.
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Qin et al. (2020) conducted a meta-analysis in Type 2 diabetes mellitus with previous ischemic stroke (n=9,218). Aspirin monotherapy vs. Clopidogrel monotherapy was evaluated on Recurrent stroke (RR 0.79, 95% CI 0.61-1.02, p=0.07). Aspirin monotherapy showed no significant difference in the risk of recurrent stroke compared to clopidogrel monotherapy (RR 0.79) for secondary prevention in patients with type 2 diabetes and previous ischemic stroke.
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