Does prior use of antiplatelet therapy modify the effect of dual antiplatelet therapy in transient ischaemic attack/minor ischaemic stroke: A systematic review and meta-analysis.
aspirin
dual antiplatelet therapy
stroke
transient ischaemic attack
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
24
05
2022
received:
17
02
2022
accepted:
25
05
2022
pubmed:
3
6
2022
medline:
9
8
2022
entrez:
2
6
2022
Statut:
ppublish
Résumé
The purpose was to determine whether prior use of antiplatelet therapy modifies the effect of dual antiplatelet therapy in patients with acute minor ischaemic stroke or transient ischaemic attack. A systematic review and meta-analysis of randomized controlled trials was performed comparing dual antiplatelet therapy to aspirin that reported subgroup analysis by prior antiplatelet use, adhering to the Cochrane Collaboration Guidelines. A fixed-effects meta-analysis was used to estimate a pooled treatment effect overall in subgroups with prior aspirin therapy and without prior aspirin therapy. Difference in treatment effect was assessed by testing p for interaction. The primary outcome measure was recurrent vascular events. Three eligible randomized controlled trials were identified, including 4831 participants with pre-existing antiplatelet use and 16,236 participants without pre-existing aspirin use. Recurrent vascular events occurred in 7.2% (95% confidence interval [CI] 4.3-10) of those without pre-existing aspirin use versus 7.3% (95% CI 4.1-10) of those receiving prior aspirin therapy. Effect of dual antiplatelet therapy on the primary outcome measure was consistent in participants with no prior aspirin use (odds ratio 0.75, 95% CI 0.66-0.84) compared to those taking aspirin before randomization (odds ratio 0.79, 95% CI 0.63-0.998) (p interaction = 0.66). The number needed to treat in the aspirin-naïve group was 55 (95% CI 37-107) compared to 66 (95% CI 32 to -746) in those on prior aspirin therapy. It was found that the effectiveness of dual antiplatelet therapy in patients with minor ischaemic stroke or high risk transient ischaemic attack does not significantly differ in patients with prior aspirin exposure; therefore there should be no influence on the decision to use dual antiplatelet therapy.
Sections du résumé
BACKGROUND AND PURPOSE
The purpose was to determine whether prior use of antiplatelet therapy modifies the effect of dual antiplatelet therapy in patients with acute minor ischaemic stroke or transient ischaemic attack.
METHODS
A systematic review and meta-analysis of randomized controlled trials was performed comparing dual antiplatelet therapy to aspirin that reported subgroup analysis by prior antiplatelet use, adhering to the Cochrane Collaboration Guidelines. A fixed-effects meta-analysis was used to estimate a pooled treatment effect overall in subgroups with prior aspirin therapy and without prior aspirin therapy. Difference in treatment effect was assessed by testing p for interaction. The primary outcome measure was recurrent vascular events.
RESULTS
Three eligible randomized controlled trials were identified, including 4831 participants with pre-existing antiplatelet use and 16,236 participants without pre-existing aspirin use. Recurrent vascular events occurred in 7.2% (95% confidence interval [CI] 4.3-10) of those without pre-existing aspirin use versus 7.3% (95% CI 4.1-10) of those receiving prior aspirin therapy. Effect of dual antiplatelet therapy on the primary outcome measure was consistent in participants with no prior aspirin use (odds ratio 0.75, 95% CI 0.66-0.84) compared to those taking aspirin before randomization (odds ratio 0.79, 95% CI 0.63-0.998) (p interaction = 0.66). The number needed to treat in the aspirin-naïve group was 55 (95% CI 37-107) compared to 66 (95% CI 32 to -746) in those on prior aspirin therapy.
CONCLUSIONS
It was found that the effectiveness of dual antiplatelet therapy in patients with minor ischaemic stroke or high risk transient ischaemic attack does not significantly differ in patients with prior aspirin exposure; therefore there should be no influence on the decision to use dual antiplatelet therapy.
Identifiants
pubmed: 35652757
doi: 10.1111/ene.15433
pmc: PMC9546427
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2864-2868Informations de copyright
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
N Engl J Med. 2013 Jul 4;369(1):11-9
pubmed: 23803136
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Stroke. 2021 Jun;52(6):e217-e223
pubmed: 33902301
N Engl J Med. 2018 Jul 19;379(3):215-225
pubmed: 29766750
N Engl J Med. 2020 Jul 16;383(3):207-217
pubmed: 32668111
Eur J Neurol. 2022 Sep;29(9):2864-2868
pubmed: 35652757
Stroke. 2016 Jan;47(1):128-34
pubmed: 26604247
Stroke. 2021 Jul;52(7):e364-e467
pubmed: 34024117
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
N Engl J Med. 2016 Apr 21;374(16):1533-42
pubmed: 27096581
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
BMJ. 2010 Mar 30;340:c117
pubmed: 20354011
PLoS One. 2014 Jul 28;9(7):e102670
pubmed: 25068257
Lancet Neurol. 2007 Nov;6(11):961-9
pubmed: 17931979
BMJ. 2018 Dec 18;363:k5108
pubmed: 30563866
Stroke. 2021 Dec;52(12):e773-e776
pubmed: 34634925