Dual versus mono antiplatelet therapy for acute non-cardio embolic ischemic stroke or transient ischemic attack, an efficacy and safety analysis-updated meta-analysis

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Dual versus mono antiplatelet therapy for
acute non-cardio embolic ischemic stroke or
transient ischemic attack, an efficacy and
safety analysis-updated meta-analysis
Christessa Emille Que Albay*,
Frederick Gavril D. Leyson and Federick C. Cheng

Abstract
Background: New evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention have been realized in the recent years. An updated meta-analysis was done to determine the effect of the various dual antiplatelet vs aspirin alone on recurrence rate of ischemic stroke, cardiovascular morbidity and mortality, and its safety profile as reported through major bleeding.

Methods: PubMed, Cochrane and Science Direct data bases were utilized, RCTs evaluating dual antiplatelet vs mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack within < 72 h from ictus were searched up to July 2019. Risk ratio at 95% confidence intervals were calculated to evaluate stroke recurrence, cardiac events and mortality, and major bleeding.

Results: Sixteen randomized controlled trials with a population of 28, 032 patients were pooled into a meta-analysis. Dual antiplatelet therapy was significantly superior over mono antiplatelet therapy in the reduction of stroke (RR 0.75, 95% CI:0.68–0.83, p value< 0.00001) and composite events namely cardiovascular morbidity and mortality (0.73 95% CI: 0.65–0.82, p value < 0.00001), while bleeding events were noted to be not significant (1.2295% CI: 0.87–1.70, p value = 0.25).

Conclusion: Among patients with acute non-cardioembolic ischemic stroke or transient ischemic attack within 72 h of ictus, dual antiplatelet therapy was associated with a reduction in stroke recurrence and composite events such as Acute Coronary Syndrome and Cardiac related deaths when compared to monotherapy. However, dual antiplatelet therapy show a decreased safety profile due to the possible, although not statistically significant, events of major bleeding as observed in this study, factors that may have contributed to the increased risk of major bleeding were the dosing and duration of treatment given. In conclusion, the current data suggests that administration of short term dual antiplatelet therapy in the acute phase of ischemic stroke or transient ischemic attack was efficacious and relatively safe, of which Cilostazol with Aspirin can be a potential for standard treatment due to its evidence in reduction of stroke recurrence and being the most cost efficient combination although with not statistically significant bleeding risk.

Keywords: Acute ischemic stroke, Non-cardioembolic stroke, Dual antiplatelet, Mono antiplatelet treatment, Aspirin, Cilostazol, Ticagrelor, Clopidogrel, Dipyridamole

Ref: Albay et al. BMC Neurology (2020) 20:224 https://doi.org/10.1186/s12883-020-01808-y

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