March 1, 2025BMJ Neurology Open0 citationsOpen Access

Impact of dual antiplatelet therapy on patients with minor stroke after thrombolysis: a systematic review and meta-analysis

MHMuhammad Hamayal WSWarda Shahid IIIqra Iftikhar

Structured PICO

Does dual antiplatelet therapy improve modified Rankin Scale score of 0-1 at 90 days in patients with minor stroke after thrombolysis compared to single antiplatelet therapy?

Population

743 patients with minor stroke (aged ≥18 years, National Institutes of Health Stroke Scale score of ≤5 or 3) who received intravenous thrombolysis prior to antiplatelet therapy, pooled from 4 cohort studies.

Intervention

Dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) after intravenous thrombolysis

Comparator

Single antiplatelet therapy (aspirin 100 mg/day) after intravenous thrombolysis

Outcome

modified Rankin Scale (mRS) score of 0-1 at 90 dayshard clinical

In patients with minor stroke who received intravenous thrombolysis, dual antiplatelet therapy showed a non-significant trend toward improved functional outcomes and reduced stroke recurrence and symptomatic intracranial hemorrhage compared to single antiplatelet therapy.

Abstract

Background: Intravenous thrombolysis for acute minor ischaemic strokes did not provide any benefit in the recent TEMPO-2 trial. In general, single antiplatelet agents are used to improve the outcomes after thrombolysis. This systematic review was done to assess the impact of dual antiplatelet therapy (DAPT) after thrombolysis in patients with minor stroke. Materials and methods: A literature search was performed on PubMed, The Cochrane Library and Science Direct for articles between 2016 and 2024. All studies included patients with minor stroke, aged ≥18 years, National Institutes of Health Stroke Scale score of ≤5 (or 3) and those who received thrombolysis prior to DAPT. The primary endpoint was modified Rankin Scale (mRS) score of 0-1 at 90 days. The quality of the studies was assessed using the Newcastle Ottawa Scale. Risk ratios (RRs) were calculated, and subgroup analysis was done. Results: Only 4 out of 4364 studies originally retrieved met the inclusion criteria and were included. The analysis showed that the mRS score improvement at 90 days was almost similar in both DAPT and single antiplatelet therapy (SAPT) groups (RR 1.09; 95% CI (0.98, 1.21), p=0.11). Risk of symptomatic intracranial haemorrhage (SICH) (RR 0.65; 95% CI (0.11, 3.97), p=0.64) and stroke recurrence (RR 0.88; 95% CI (0.44, 1.78), p=0.64) was reduced with DAPT compared with SAPT without any major significance. Conclusion: While these findings could not establish the superiority of DAPT over SAPT, DAPT showed slightly better results in functional outcomes, reducing the risk of stroke recurrence and SICH after thrombolysis in patients with minor stroke. PROSPERO registration number: CRD42024593717.

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