Short-term DAPT (≤3 months) reduced the risk of ischaemic stroke recurrence by 41% and major vascular events by 30% without increasing intracranial hemorrhage, appearing superior to prolonged DAPT.
Meta-Analysis (n=21,923)
Does short-term or prolonged dual antiplatelet therapy (aspirin and clopidogrel) reduce ischaemic stroke recurrence and major vascular events in patients with minor ischaemic stroke or TIA?
Short-term (≤3 months) DAPT with aspirin and clopidogrel is superior to prolonged (≥1 year) DAPT for secondary prevention after minor stroke or TIA, as it reduces ischemic events without increasing bleeding risk.
Effect estimate: 41% risk reduction
BACKGROUND AND PURPOSE: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 90 days was recommended as the secondary prevention of minor ischaemic strokes or transient ischaemic attacks (TIAs) in 2014. However, whether the duration of 90 days is optimal for each patient remains unclear. Therefore, the efficacy and safety of short-term (≤3 months) and prolonged (≥1 year) DAPT after stroke or TIA were assessed via a systematic review and meta-analysis. METHODS: The Cochrane Library, Clinical Trials.gov and PubMed were searched up to December 2014 and nine randomized controlled trials were included involving 21 923 patients. RESULTS: Short-term DAPT significantly reduced the risk of ischaemic stroke recurrence by 41% and major vascular events by 30%, without increasing the risk of intracranial haemorrhage. Prolonged DAPT reduced the risk of ischaemic stroke recurrence by 12% and major vascular events by 10%. However, the risk of major bleeding and intracranial haemorrhage increased. CONCLUSIONS: Short-term DAPT appears to be superior to prolonged DAPT. However, the difference in efficacy outcome needs to be carefully explained and confirmed by further well-designed randomized controlled trials.
Ge et al. (Mon,) conducted a meta-analysis in stroke or transient ischaemic attack (n=21,923). Short-term dual antiplatelet therapy (aspirin and clopidogrel) vs. Prolonged dual antiplatelet therapy was evaluated on ischaemic stroke recurrence (41% risk reduction). Short-term DAPT (≤3 months) reduced the risk of ischaemic stroke recurrence by 41% and major vascular events by 30% without increasing intracranial hemorrhage, appearing superior to prolonged DAPT.