Early Dual versus Mono Antiplatelet Therapy for Acute Non-Cardioembolic Ischemic Stroke or Transient Ischemic Attack: An Updated Systematic Review and Meta-Analysis
Background—Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke (IS) and transient ischemic attack (TIA). We performed a meta-analysis of randomized controlled trials (RCTs) evaluating dual versus mono antiplatelet therapy for acute non-cardioembolic IS or TIA.
Methods and Results—We assessed RCTs investigating dual versus mono antiplatelet therapy published up to November 2012 and the CHANCE trial (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), for efficacy and safety outcomes in adult patients with acute non-cardioembolic IS or TIA with treatment initiated within 3 days of ictus. In total, 14 studies of 9,012 patients were included in the systematic review and meta-analysis. Dual antiplatelet therapy significantly reduced risk of stroke recurrence (RR 0.69, 95%CI 0.60-0.80, P<0.001) and the composite outcome of stroke, TIA, acute coronary syndrome (ACS) and all death (RR 0.71, 95%CI 0.63-0.81, P<0.001) when compared with monotherapy, and non-significantly increased risk of major bleeding (RR 1.35, 95%CI 0.70-2.59, P=0.37). Analyses restricted to the CHANCE Trial or the 7 double-blind RCTs showed similar results.
Conclusions—For patients with acute non-cardioembolic ischemic stroke or TIA, dual therapy was more effective than monotherapy in reducing risks of early recurrent stroke. The results of the CHANCE study are consistent with previous studies done in other parts of the world.
- Received April 15, 2013.
- Revision received August 1, 2013.
- Accepted August 5, 2013.