Clopidogrel, aspirin both okay for secondary stroke prevention in T2D

  • Qin ZY & al.
  • Diabetes Ther
  • 27 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Clopidogrel and aspirin monotherapy are equally safe and effective for secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke in patients with type 2 diabetes (T2D).

Why this matters

  • Aspirin is recommended as initial treatment for secondary prevention of recurrent ischemic stroke in patients with T2D, but some cannot tolerate aspirin.   

Study design

  • Systematic review, meta-analysis of 6 studies involving 9218 participants with T2D who had previous ischemic stroke, with 4917 taking aspirin and 4301 taking clopidogrel.
  • Funding: None.

Key results

  • No significant difference in recurrent stroke (risk ratio [RR], 0.79; 95% CI, 0.61-1.02; P=.07) with aspirin vs clopidogrel monotherapy for secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke.
  • Risks between treatment groups were similar for fatal stroke (RR, 0.88; P=.76), cerebral hemorrhage (RR, 0.65; P=.12), myocardial infarction (RR, 0.88; P=.71), and mortality (RR, 1.07; P=.44).

Limitations

  • Total participant number might have yielded insufficient power.
  • Limited number of studies on this specific topic.
  • Only 2 studies had assessed fatal stroke and myocardial infarction.
  • Other important outcomes and adverse drug events including gastrointestinal bleeding, abdominal pain, melena, and other bleeding not reported.
  • Data from randomized and observational studies combined.