Secondary stroke prevention: dual antiplatelet therapy tops aspirin, but not clopidogrel in elderly

  • Ding L & al.
  • Eur J Neurol
  • 1 Jun 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Included trials did not exclusively include elderly patients.
  • Age distribution data were not available.