Optimal Duration of Aspirin Plus Clopidogrel After Ischemic Stroke or Transient Ischemic Attack

  • Hammad Rahman
    From the Department of Medicine (H.R., F.N., E.K.), Guthrie Health System/Robert Packer Hospital, Sayre, PA
  • Safi U. Khan
    Department of Medicine, West Virginia University, Morgantown (S.U.K.)
  • Fahad Nasir
    From the Department of Medicine (H.R., F.N., E.K.), Guthrie Health System/Robert Packer Hospital, Sayre, PA
  • Tehseen Hammad
    Department of Medicine, Services Hospital, Lahore, Pakistan (T.H.)
  • Michael A. Meyer
    Division of Neurology (M.A.M.), Guthrie Health System/Robert Packer Hospital, Sayre, PA
  • Edo Kaluski
    From the Department of Medicine (H.R., F.N., E.K.), Guthrie Health System/Robert Packer Hospital, Sayre, PA

書誌事項

タイトル別名
  • A Systematic Review and Meta-Analysis

抄録

<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Ten randomized controlled trials (15 434 patients) were selected using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (inception June 2018) comparing A+C with aspirin monotherapy in patients with transient ischemic attack or IS. The primary efficacy outcome was recurrent IS, and the primary safety outcome was major bleeding. The secondary outcomes were major adverse cardiovascular events (composite of stroke, myocardial infarction, and cardiovascular mortality) and all-cause mortality. We stratified analysis based on the short- (≤1 month), intermediate- (≤3 month), and long-term (>3 month) A+C therapy. Effects were estimated as relative risk (RR) with 95% CI.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>A+C significantly reduced the risk of recurrent IS at short-term (RR, 0.53; 95% CI, 0.37–0.78) and intermediate-term (RR, 0.72; 95% CI, 0.58–0.90) durations. Similarly, major adverse cardiovascular event was significantly reduced by short-term (RR, 0.68; 95% CI, 0.60–0.78) and intermediate-term (RR, 0.76; 95% CI, 0.61–0.94) A+C therapy. However, long-term A+C did not yield beneficial effect in terms of recurrent IS (RR, 0.81; 95% CI, 0.63–1.04) and major adverse cardiovascular events (RR, 0.87; 95% CI, 0.71–1.07). Intermediate-term (RR, 2.58; 95% CI, 1.19–5.60) and long-term (RR, 1.87; 95% CI, 1.36–2.56) A+C regimens significantly increased the risk of major bleeding as opposed to short-term A+C (RR, 1.82; 95% CI, 0.91–3.62). Excessive all-cause mortality was limited to long-term A+C (RR, 1.45; 95% CI, 1.10–1.93).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Short-term A+C is more effective and equally safe in comparison to aspirin alone in patients with acute IS or transient ischemic attack.</jats:p> </jats:sec>

収録刊行物

  • Stroke

    Stroke 50 (4), 947-953, 2019-04

    Ovid Technologies (Wolters Kluwer Health)

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