Dual antiplatelet therapy significantly reduced recurrent stroke risk compared to aspirin monotherapy (RR 0.79; 95% CI 0.69-0.91; P=0.001), but increased bleeding risk in elderly patients.
Meta-Analysis (n=24,873)
Yes
Does dual antiplatelet therapy reduce stroke recurrence compared to mono antiplatelet therapy in elderly patients with ischaemic stroke or TIA?
In elderly patients with ischaemic stroke or TIA, DAPT reduces recurrent stroke compared to aspirin but not clopidogrel, while increasing bleeding risks.
Relative Risk: 0.79 (95% CI 0.69–0.91)
p-value: p=0.001
BACKGROUND AND PURPOSE: There is a lack of age-specific evidence regarding the efficacy and safety of dual antiplatelet therapy (DAPT). A systematic review and meta-analysis was conducted for dual versus mono antiplatelet therapy in elderly patients with ischaemic stroke (IS) or transient ischaemic attack (TIA). METHODS: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Risk ratios (RRs) for the outcomes of stroke recurrence, major bleeding and intracranial bleeding were calculated based on the DerSimonian and Laird random effects model. Subgroup analyses were conducted. RESULTS: In seven multicentre, randomized controlled trials comprising 24 873 patients with IS or TIA, aged 65 years or older, a significant reduction in the risk of recurrent stroke was observed using DAPT in comparison with aspirin monotherapy RR 0.79, 95% confidence interval (95% CI) 0.69-0.91; P = 0.001. DAPT was not associated with a significant reduction in recurrent stroke compared with clopidogrel monotherapy (RR 1.01, 95% CI 0.93-1.10; P = 0.800). In addition, the results from two studies showed that DAPT significantly increased the risk of major bleeding and intracranial bleeding in elderly patients over younger patients (RR 2.18, 95% CI 1.02-4.69; and RR 2.13, 95% CI 1.18-3.86, respectively). CONCLUSIONS: For stroke prevention in elderly patients with IS or TIA, DAPT is superior to aspirin monotherapy but appears to be equivalent to clopidogrel monotherapy, and is accompanied by an increased risk of bleeding. The balance between the benefits and risks of DAPT is important to consider when choosing antiplatelet strategy.
Ding et al. (Fri,) conducted a meta-analysis in ischaemic stroke (IS) or transient ischaemic attack (TIA) (n=24,873). Dual antiplatelet therapy vs. Aspirin monotherapy was evaluated on recurrent stroke (RR 0.79, 95% CI 0.69-0.91, p=0.001). Dual antiplatelet therapy significantly reduced recurrent stroke risk compared to aspirin monotherapy (RR 0.79; 95% CI 0.69-0.91; P=0.001), but increased bleeding risk in elderly patients.