- In elderly patients with ischaemic stroke (IS) or transient ischaemic attack (TIA), dual antiplatelet therapy (DAPT) is superior to aspirin monotherapy for prevention of recurrent stroke, but not to clopidogrel monotherapy.
- DAPT was associated with increased risk for bleeding.
Why this matters
- Benefits and risks for DAPT must be considered when choosing an antiplatelet strategy in elderly.
- Meta-analysis of 7 randomised controlled studies including 24,873 elderly patients (age, ≥65 years) with IS/TIA identified after a search on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials.
- Funding: National Key Research and Development Program of China; National Natural Science Foundation of China.
- DAPT significantly reduced the risk for recurrent stroke vs aspirin monotherapy (risk ratio [RR], 0.79; P=.001).
- Risk for recurrent stroke was not significantly different between DAPT and clopidogrel monotherapy (RR, 1.01; P=.800).
- DAPT increased the risk for major bleeding (RR, 2.18; 95% CI, 1.02-4.69) and intracranial bleeding (RR, 2.13; 95% CI, 1.18-3.86) in elderly patients than in younger patients.
- Included trials did not exclusively include elderly patients.
- Age distribution data were not available.