Takeaway
- Among patients who were presented with ischaemic stroke/transient ischaemic attack (TIA), the combination of clopidogrel plus aspirin was associated with a significant reduction of recurrent stroke with no increased risk for vascular events or mortality vs antiplatelet monotherapy.
- Dual antiplatelet therapy (DAPT) was associated with higher rates of bleeding.
- DAPT given shortly (1 week) and for shorter duration (≤1 month) after the ischaemic event was associated with lower risk for bleeding.
Why this matters
- Current guidelines recommend 21 days of clopidogrel plus aspirin treatment only in patients presenting with minor stroke.
Study design
- Meta-analysis of 16 randomised controlled trials including 29,032 patients who received either clopidogrel plus aspirin or antiplatelet monotherapy.
- Funding: None disclosed.
Key results
- Compared with monotherapy, clopidogrel plus aspirin was associated with significantly lower rates of any stroke (7.6% vs 9.2%; risk ratio [RR], 0.80; P<.001) and recurrent ischaemic strokes (6.7% vs 8.6%; RR, 0.75; P<.001).
- Risk for intracranial bleeding (RR, 1.55; P<.001) and major bleeding (RR, 1.90; P<.001) was significantly higher with DAPT.
- No events were observed in patients who received DAPT within 1 week of index events.
- Shorter duration of DAPT (≤1 month of index event) was not associated with higher risk for intracranial (RR, 1.36; 95% CI, 0.79-2.32) or major bleeding (RR, 1.68; 95% CI, 0.73-3.83).
- No difference was observed in TIA (RR, 0.88; P=.19), myocardial infarction (RR, 1.04; P=.70), vascular death (RR, 0.99; P=.91), and any death (RR, 1.12; P=.36).
Limitations
- Heterogeneity between studies.
References
References
