Dual anti-platelet therapy for secondary prevention in intracranial atherosclerotic disease: a network meta-analysis.
DAPT
ICAS
anti-platelet therapy
arterial stenosis
cerebrovascular disease
dual anti-platelet therapy
intracranial arterial stenosis
intracranial atherosclerosis disease
intracranial stenosis
meta-analysis
stroke
Journal
Therapeutic advances in neurological disorders
ISSN: 1756-2856
Titre abrégé: Ther Adv Neurol Disord
Pays: England
ID NLM: 101480242
Informations de publication
Date de publication:
2022
2022
Historique:
received:
17
02
2022
accepted:
03
07
2022
entrez:
12
8
2022
pubmed:
13
8
2022
medline:
13
8
2022
Statut:
epublish
Résumé
Intracranial arterial stenosis (ICAS) is a non-marginal cause of stroke/transient ischemic attacks (TIAs) and is associated with high stroke recurrence rate. Some studies have investigated the best secondary prevention ranging from antithrombotic therapy to endovascular treatment (ET). However, no direct comparison between all the possible treatments is currently available especially between single and dual anti-platelet therapies (SAPT and DAPT). To establish whether DAPT is more effective than SAPT in preventing the recurrence of ICAS-related stroke, by means of a network meta-analysis (NMA). Systematic review and NMA in accordance to PRISMA guidelines. We performed a systematic review of trials investigating secondary prevention (SAPT or DAPT, anticoagulant treatment or ET) in patients with symptomatic ICAS available in MEDLINE, Scopus and Web of Science from January 1989 to May 2021. We defined our primary efficacy outcome as the recurrence of ischemic stroke/TIA. We analysed the extracted data with Bayesian NMA approach. We identified 815 studies and included 5 trials in the NMA. Sequence generation was adequate in all the selected studies while the allocation concealment method was described in one study. All the included studies reported the pre-specified primary outcomes, and outcome assessment was blinded in all the studies. We used the fixed-effect approach as the heterogeneity was not significant ( DAPT is more effective than SAPT for secondary stroke prevention in patients with symptomatic ICAS, without increasing the risk of haemorrhage. Prospero/CRD42019140033.
Sections du résumé
Background
UNASSIGNED
Intracranial arterial stenosis (ICAS) is a non-marginal cause of stroke/transient ischemic attacks (TIAs) and is associated with high stroke recurrence rate. Some studies have investigated the best secondary prevention ranging from antithrombotic therapy to endovascular treatment (ET). However, no direct comparison between all the possible treatments is currently available especially between single and dual anti-platelet therapies (SAPT and DAPT).
Aim
UNASSIGNED
To establish whether DAPT is more effective than SAPT in preventing the recurrence of ICAS-related stroke, by means of a network meta-analysis (NMA).
Design
UNASSIGNED
Systematic review and NMA in accordance to PRISMA guidelines.
Data sources and methods
UNASSIGNED
We performed a systematic review of trials investigating secondary prevention (SAPT or DAPT, anticoagulant treatment or ET) in patients with symptomatic ICAS available in MEDLINE, Scopus and Web of Science from January 1989 to May 2021. We defined our primary efficacy outcome as the recurrence of ischemic stroke/TIA. We analysed the extracted data with Bayesian NMA approach.
Results
UNASSIGNED
We identified 815 studies and included 5 trials in the NMA. Sequence generation was adequate in all the selected studies while the allocation concealment method was described in one study. All the included studies reported the pre-specified primary outcomes, and outcome assessment was blinded in all the studies. We used the fixed-effect approach as the heterogeneity was not significant (
Conclusion
UNASSIGNED
DAPT is more effective than SAPT for secondary stroke prevention in patients with symptomatic ICAS, without increasing the risk of haemorrhage.
Registration
UNASSIGNED
Prospero/CRD42019140033.
Identifiants
pubmed: 35958039
doi: 10.1177/17562864221114716
pii: 10.1177_17562864221114716
pmc: PMC9358568
doi:
Types de publication
Journal Article
Langues
eng
Pagination
17562864221114716Informations de copyright
© The Author(s), 2022.
Déclaration de conflit d'intérêts
Competing interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
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