Dual vs. mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack with evidence of large artery atherosclerosis.

Background and purpose

Current pieces of evidence support the short-term use of dual antiplatelet (DAPT) in minor ischemic stroke or transient ischemic attack (TIA) based on the studies performed in patients with a broad range of non-cardioembolic stroke mechanisms. However, the efficacy and safety of DAPT use in ischemic stroke patients with large artery atherosclerosis (LAA) are still uncertain. We undertook a systemic search and formal meta-analysis to compare DAPT vs. mono-antiplatelet therapy (MAPT) in patients with etiology specifically presumed to be symptomatic LAA.

Methods

We conducted a systemic online search for completed randomized controlled trials that (1) compared DAPT vs. MAPT in patients with acute ischemic stroke or TIA, and (2) were confined to or had available subgroup data regarding population with symptomatic extra- or intracranial artery stenosis. Study-level meta-analysis was performed for outcomes, including ischemic stroke (IS) recurrence, intracranial hemorrhage (ICH), and major bleeding with the Mantel-Haenszel method and random effect models, and was described as risk difference (RD) and 95% CI.

Results

A total of 10 trials including 5,004 patients were pooled. Comparing to MAPT, DAPT significantly reduced IS recurrence (5.99 vs. 9.55%, RD: -3%, 95% CI: -5

Conclusion

In patients with symptomatic large artery extracranial or intracranial atherosclerosis, DAPT was superior to MAPT in preventing IS recurrence without increasing bleeding risks. The optimal DAPT regimens and duration of treatment in this population need to be clarified in further studies.

Informations de copyright

Copyright © 2022 Lin, Tseng and Saver.

Déclaration de conflit d'intérêts

Author JS is an employee of the University of California. The University of California has patent rights in retrieval devices for stroke. He has served as an unpaid site investigator in multicenter trials sponsored by Medtronic, Stryker, and Neuravia, for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled; has received funding for services as a scientific consultant regarding trial design and conduct to Medtronic, Stryker, Neuravi/Cerenovus and Boehringer Ingelheim (prevention only), and stock options for services as a scientific consultant regarding trial design and conduct to Rapid Medical. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.