Abstract | OBJECTIVE: METHODS: We searched PubMed and Scopus until August 28, 2019, for randomized trials comparing oral anticoagulants vs antiplatelets in patients with stroke and supracardiac atherosclerosis using the terms " anticoagulant or anticoagulation" and "antiplatelet or aspirin" and "randomized controlled trial or RCT" and " stroke or cerebral ischemia" and "aortic or carotid or vertebrobasilar or intracranial or atherosclerosis or stenosis or arterial." Four outcomes were assessed: recurrent ischemic stroke, major ischemic event or death, major bleeding, and intracranial bleeding. Treatment effects (relative risk [RR] and 95% confidence interval [CI]) were estimated by meta-analysis using random-effects models. RESULTS: Among 1,117 articles identified in the literature search, results from 10 randomized controlled trials involving 6,068 patients with stroke/TIA with supracardiac atherosclerosis were included in the meta-analysis. Recurrent ischemic stroke rates were 2.94 per 100 patient-years in the anticoagulant-assigned patients vs 3.30 per 100 patient-years in the antiplatelet-assigned patients (RR, 0.91; 95% CI, 0.70-1.18 for the SJ estimator, I2 = 26%). Major ischemic event or death rates were 4.39 per 100 patient-years in anticoagulant-assigned patients vs 4.32 in antiplatelet-assigned patients (RR, 1.03; 95% CI, 0.79-1.35; I2 = 54.5%). Major bleeding rates were 2.88 per 100 patient-years in anticoagulant-assigned patients vs 0.82 in antiplatelet-assigned patients (RR, 3.21; 95% CI, 1.96-5.24; I2 = 46%). CONCLUSION:
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Authors | Dimitrios Sagris, Georgios Georgiopoulos, Ioannis Leventis, Konstantinos Pateras, Lesly A Pearce, Eleni Korompoki, Konstantinos Makaritsis, Konstantinos Vemmos, Haralampos Milionis, George Ntaios |
Journal | Neurology
(Neurology)
Vol. 95
Issue 5
Pg. e499-e507
(08 04 2020)
ISSN: 1526-632X [Electronic] United States |
PMID | 32631920
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
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Copyright | © 2020 American Academy of Neurology. |
Chemical References |
- Anticoagulants
- Platelet Aggregation Inhibitors
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Topics |
- Anticoagulants
(therapeutic use)
- Aortic Diseases
(complications)
- Atherosclerosis
(complications)
- Humans
- Intracranial Arteriosclerosis
(complications)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Stroke
(drug therapy, etiology)
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