Long-Term Antiplatelet Mono- and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta-Analysis.

Abstract

BACKGROUND:

The latest guidelines do not make clear recommendations on the selection of antiplatelet therapies for long-term secondary prevention of stroke. We aimed to integrate the available evidence to create hierarchies of the comparative efficacy and safety of long-term antiplatelet therapies after ischemic stroke or transient ischemic attack.

METHODS AND RESULTS:

We performed a network meta-analysis of randomized controlled trials to compare 11 antiplatelet therapies in patients with ischemic stroke or transient ischemic attack. In December 2014, we searched Medline, Embase, and the Cochrane Library database for trials. The search identified 24 randomized controlled trials including a total of 85 667 patients with antiplatelet treatments for at least 1 year. Cilostazol significantly reduced stroke recurrence in comparison with aspirin (odds ratio 0.66, 95% credible interval 0.44 to 0.92) and dipyridamole (odds ratio 0.57, 95% credible interval 0.34 to 0.95), respectively. Cilostazol also significantly reduced intracranial hemorrhage compared with aspirin, clopidogrel, terutroban, ticlopidine, aspirin plus clopidogrel, and aspirin plus dipyridamole. Aspirin plus clopidogrel could not significantly reduce stroke recurrence compared with monotherapies but caused significantly more major bleeding than all monotherapies except terutroban. The pooled estimates did not change materially in the sensitivity analyses of the primary efficacy outcome.

CONCLUSIONS:

Long-term monotherapy was a better choice than long-term dual therapy, and cilostazol had the best risk-benefit profile for long-term secondary prevention after stroke or transient ischemic attack. More randomized controlled trials in non-East Asian patients are needed to determine whether long-term use of cilostazol is the best option for the prevention of recurrent stroke.

• Authors: Wuxiang Xie, Fanfan Zheng, Baoliang Zhong, Xiaoyu Song
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 4 Issue 8 Pg. e002259 (Aug 24 2015) ISSN: 2047-9980 [Electronic] England
• PMID: 26304937 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)
• Copyright: © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Drug Administration Schedule
• Drug Therapy, Combination
• Humans
• Ischemic Attack, Transient (blood, diagnosis, drug therapy)
• Odds Ratio
• Patient Selection
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Randomized Controlled Trials as Topic
• Recurrence
• Risk Factors
• Secondary Prevention (methods)
• Stroke (blood, diagnosis, drug therapy)
• Time Factors
• Treatment Outcome