NEW YORK (Reuters Health) – Dual rather than mono antiplatelet therapy started soon after ischemic stroke reduces the risk of recurrence without a significant increase in risk of major bleeding, according to the results of a meta-analysis reported in Stroke published online January 26.
However, the authors caution, “The present study had relatively small numbers of outcome events; it is primarily only hypothesis-generating and should not lead to modification of treatment paradigms.”
Dr. Philip M. W. Bath, with the University of Nottingham, UK, and colleagues note that various combinations of antiplatelet agents have been tested in patients with acute stroke. They explain that evidence from these studies indicates that, in terms of safety and efficacy, the number of agents is more important than specific combinations.
To investigate further, they identified 12 randomized trials in which dual antiplatelet drugs were compared to a single antiplatelet agent in patients within 3 days of having a stroke or TIA. The trials included a total of 3766 patients and compared two dual combinations — aspirin plus dipyridamole and aspirin plus clopidogrel — against each of the three agents as monotherapy.
Analysis of the pooled data showed that stroke recurrence was 3.3% with dual therapy and 5.0% with monotherapy (risk ratio 0.67), a significant difference.
Similarly, the investigators found that dual versus mono antiplatelet therapy significantly reduced the composite outcomes of stroke, MI and vascular death (risk ratio 0.75) and stroke, TIA, ACS and death (risk ratio 0.71).
While the risk of major bleeding was doubled with dual therapy (0.9% vs 0.4%; risk ratio 2.09), the difference was not statistically significant, Dr. Bath and colleagues found.
“No individual comparison of specific dual versus mono antiplatelet combinations altered stroke or any other outcome,” they add.
Overall, the authors conclude, “Dual antiplatelet therapy appears to be safe and effective in reducing stroke recurrence and combined vascular events in patients with acute ischemic stroke or transient ischemic attack as compared with mono therapy. These results need to be tested in prospective studies.”
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