Ischaemic stroke: shorter duration of dual antiplatelet therapy minimises bleeding events

  • Kheiri B & al.
  • J Thromb Thrombolysis
  • 3 Dec 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • 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 vs rr p>
  • Risk for intracranial bleeding (RR, 1.55; P<.001 and major bleeding p 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).


  • Heterogeneity between studies.

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