AI helps you reading Science

AI generates interpretation videos

AI extracts and analyses the key points of the paper to generate videos automatically


pub
Go Generating

AI Traceability

AI parses the academic lineage of this thesis


Master Reading Tree
Generate MRT

AI Insight

AI extracts a summary of this paper


Weibo:
Use of dual antiplatelet therapy was effective in reducing the risk of early stroke recurrence and other vascular events, when compared with mono antiplatelet therapy in patients with acute noncardioembolic ischemic stroke or transient ischemic attack

Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis.

CEREBROVASCULAR DISEASES, no. SUPnan (2013): 37-37

Cited: 101|Views128
WOS

Abstract

Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA). We performed a meta-analysis of randomized, controlled trials evaluating dual versus mono antiplat...More

Code:

Data:

0
Introduction
  • Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA).
  • The authors performed a meta-analysis of randomized, controlled trials evaluating dual versus mono antiplatelet therapy for acute noncardioembolic ischemic stroke or TIA
Highlights
  • Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA)
  • For patients with acute noncardioembolic ischemic stroke or transient ischemic attack, dual therapy was more effective than monotherapy in reducing risks of early recurrent stroke
  • Patients with ischemic stroke (IS) or transient ischemic attack (TIA) are at high risk of recurrent stroke, and a considerable proportion of these recurrent events occur during the first few days after the index stroke or transient ischemic attack.[1,2,3,4]
  • Besides CHANCE, only 1 other eligible RCT published after January 2011 was identified, which compared cilostazol (100 mg bd) plus aspirin (300 mg loading dose 100 mg od) versus aspirin alone (300 mg loading dose 100 mg od) in 76 adult patients with acute noncardioembolic ischemic stroke, though whether treatment was blinded is unknown.[29]
  • We found that when compared with mono antiplatelet therapy, dual therapy was associated with a reduction in stroke recurrence, and composite vascular events, but without a significant increase in the risk of major bleeding
  • The risk of major bleeding tended to be increased with dual therapy, this was not statistically significant (RR, 2.09; 95% CI, 0.86–5.06, P=0.10).[16]
  • Early use of dual antiplatelet therapy was effective in reducing the risk of early stroke recurrence and other vascular events, when compared with mono antiplatelet therapy in patients with acute noncardioembolic ischemic stroke or transient ischemic attack
Methods
  • The authors updated the previous systematic review published in Stroke in 2011,16 with the new review including the eligible studies up to November 2012 plus CHANCE.[17,18] The 12 eligible studies up to April 2011 in the previous meta-analysis[16] were included in this current meta-analysis.
Results
  • The authors assessed randomized, controlled trials investigating dual versus mono antiplatelet therapy published up to November 2012 and the CHANCE trial (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), for efficacy and safety outcomes in adult patients with acute noncardioembolic ischemic stroke or TIA with treatment initiated within 3 days of ictus.
  • In total, there were 14 studies with 9012 patients in the present systematic review and meta-analysis, among which 7 were double-blind, 9 were intention-to-treat, and 11 had concealed allocation.
  • For those trials that had a recruitment window extending beyond three days after the index event, the authors only used data from those patients recruited and randomized within the 3-day time window.[10,11,14,24,26]
Conclusion
  • In this systematic review and meta-analysis, the authors included 14 RCTs (9012 patients) comparing dual versus mono antiplatelet therapy for acute noncardioembolic IS or TIA within 3 days of ictus.
  • Other subgroup analyses showed no significant reduction in stroke recurrence and the composite efficacy outcome in patients treated with dual therapy, which were consistent with the previous meta-analysis.[16] aspirin plus dipyridamole was found to be not significantly different from aspirin alone on the efficacy and safety outcomes in the present meta-analysis
  • This did not challenge recommendations of aspirin plus dipyridamole for management of IS and TIA in current guidelines,[6,7] because only patients recruited and randomized within 3 days of ictus, which was a small portion of subjects recruited in the RCTs assessing treatment effects of aspirin plus dipyridamole versus aspirin alone in IS or TIA patients, were analyzed in the present meta-analysis.
Tables
  • Table1: Design and Baseline Characteristics of Included Trials
  • Table2: Sensitivity Analyses for Efficacy and Safety Outcomes (Dual Versus Mono Antiplatelet Therapy)
Download tables as Excel
Funding
  • This research was supported by the Ministry of Science and Technology of the People’s Republic of China (grant Nos. 2008ZX09312-008, 2011BAI08B02, 2012ZX09303, and 200902004), and the S
Reference
  • Dhamoon MS, Sciacca RR, Rundek T, Sacco RL, Elkind MS. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006;66:641–646.
    Google ScholarLocate open access versionFindings
  • Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;42:1489–1494.
    Google ScholarLocate open access versionFindings
  • Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, Lovelock CE, Binney LE, Bull LM, Cuthbertson FC, Welch SJ, Bosch S, Alexander FC, Carasco-Alexander F, Silver LE, Gutnikov SA, Mehta Z; Early use of Existing Preventive Strategies for Stroke (EXPRESS) study. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370: 1432–1442.
    Google ScholarLocate open access versionFindings
  • Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6:1063–1072.
    Google ScholarLocate open access versionFindings
  • Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.
    Google ScholarLocate open access versionFindings
  • European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507.
    Google ScholarFindings
  • Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227–276.
    Google ScholarLocate open access versionFindings
  • National Collaborating Centre for Chronic Conditions (UK). National clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines. 2008.
    Google ScholarFindings
  • Geeganage C, Wilcox R, Bath PM. Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis. BMC Med. 2010;8:36.
    Google ScholarLocate open access versionFindings
  • Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–337.
    Google ScholarLocate open access versionFindings
  • Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ; CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706–1717.
    Google ScholarLocate open access versionFindings
  • Bath PM, Cotton D, Martin RH, Palesch Y, Yusuf S, Sacco R, Diener HC, Estol C, Roberts R; PRoFESS Study Group. Effect of combined aspirin and extended-release dipyridamole versus clopidogrel on functional outcome and recurrence in acute, mild ischemic stroke: PRoFESS subgroup analysis. Stroke. 2010;41:732–738.
    Google ScholarLocate open access versionFindings
  • Sacco RL, Diener HC, Yusuf S, Cotton D, Ounpuu S, Lawton WA, Palesch Y, Martin RH, Albers GW, Bath P, Bornstein N, Chan BP, Chen ST, Cunha L, Dahlöf B, De Keyser J, Donnan GA, Estol C, Gorelick P, Gu V, Hermansson K, Hilbrich L, Kaste M, Lu C, Machnig T, Pais P, Roberts R, Skvortsova V, Teal P, Toni D, Vandermaelen C, Voigt T, Weber M, Yoon BW; PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359:1238–1251.
    Google ScholarLocate open access versionFindings
  • Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111:2233–2240.
    Google ScholarLocate open access versionFindings
  • Wong KS, Chen C, Fu J, Chang HM, Suwanwela NC, Huang YN, Han Z, Tan KS, Ratanakorn D, Chollate P, Zhao Y, Koh A, Hao Q, Markus HS; CLAIR study investigators. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blindedendpoint trial. Lancet Neurol. 2010;9:489–497.
    Google ScholarLocate open access versionFindings
  • Geeganage CM, Diener HC, Algra A, Chen C, Topol EJ, Dengler R, Markus HS, Bath MW, Bath PM; Acute Antiplatelet Stroke Trialists Collaboration. Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and metaanalysis of randomized controlled trials. Stroke. 2012;43:1058–1066.
    Google ScholarLocate open access versionFindings
  • Wang Y, Johnston SC; CHANCE Investigators. Rationale and design of a randomized, double-blind trial comparing the effects of a 3-month clopidogrel-aspirin regimen versus aspirin alone for the treatment of highrisk patients with acute nondisabling cerebrovascular event. Am Heart J. 2010;160:380–386.e1.
    Google ScholarLocate open access versionFindings
  • Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11–19.
    Google ScholarLocate open access versionFindings
  • The GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329:673–682.
    Google ScholarLocate open access versionFindings
  • DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188.
    Google ScholarLocate open access versionFindings
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
    Google ScholarLocate open access versionFindings
  • Matías-Guiu J, Dávalos A, Picó M, Monasterio J, Vilaseca J, Codina A. Low-dose acetylsalicylic acid (ASA) plus dipyridamole versus dipyridamole alone in the prevention of stroke in patients with reversible ischemic attacks. Acta Neurol Scand. 1987;76:413–421.
    Google ScholarLocate open access versionFindings
  • Kaye J. A trial to evaluate the relative roles of dipyridamole and aspirin in the prevention of deep vein thrombosis in stroke patients. Bracknell: Boehringer-Ingelheim. 1989.
    Google ScholarFindings
  • Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1–13.
    Google ScholarLocate open access versionFindings
  • Chairangsarit P, Sithinamsuwan P, Niyasom S, Udommongkol C, Nidhinandana S, Suwantamee J. Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study. J Med Assoc Thai. 2005;88 Suppl 3:S148–S154.
    Google ScholarLocate open access versionFindings
  • Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367:1665–1673.
    Google ScholarLocate open access versionFindings
  • Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM; FASTER Investigators. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 2007;6:961–969.
    Google ScholarLocate open access versionFindings
  • Dengler R, Diener HC, Schwartz A, Grond M, Schumacher H, Machnig T, Eschenfelder CC, Leonard J, Weissenborn K, Kastrup A, Haberl R; EARLY Investigators. Early treatment with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke within 24 h of symptom onset (EARLY trial): a randomised, open-label, blindedendpoint trial. Lancet Neurol. 2010;9:159–166.
    Google ScholarLocate open access versionFindings
  • Nakamura T, Tsuruta S, Uchiyama S. Cilostazol combined with aspirin prevents early neurological deterioration in patients with acute ischemic stroke: a pilot study. J Neurol Sci. 2012;313:22–26.
    Google ScholarLocate open access versionFindings
  • Benavente OR, White CL, Pearce L, Pergola P, Roldan A, Benavente MF, Coffey C, McClure LA, Szychowski JM, Conwit R, Heberling PA, Howard G, Bazan C, Vidal-Pergola G, Talbert R, Hart RG; SPS3 Investigators. The Secondary Prevention of Small Subcortical Strokes (SPS3) study. Int J Stroke. 2011;6:164–175.
    Google ScholarLocate open access versionFindings
  • Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS, Pearce LA. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012;367:817–825. Circulation. 2013;128:1656-1666; originally published online September 12, 2013; doi: 10.1161/CIRCULATIONAHA.113.003187
    Locate open access versionFindings
  • The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/128/15/1656
    Findings
  • Data Supplement (unedited) at: http://circ.ahajournals.org/content/suppl/2013/09/11/CIRCULATIONAHA.113.003187.DC1
    Findings
  • Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at:http://circ.ahajournals.org//subscriptions/
    Locate open access versionFindings
  • Legend Supplemental Figure 1. Flow chart for selection of published eligible studies from January 2011 to November 2012.
    Google ScholarFindings
0
Your rating :

No Ratings

Tags
Comments
数据免责声明
页面数据均来自互联网公开来源、合作出版商和通过AI技术自动分析结果,我们不对页面数据的有效性、准确性、正确性、可靠性、完整性和及时性做出任何承诺和保证。若有疑问,可以通过电子邮件方式联系我们:report@aminer.cn