Abstract WP144: Long Term Safety And Efficacy Of Dual Versus Mono Antiplatelet Therapy In Patients With Previous Stroke Or TIA
Background: In comparison with mono antiplatelet therapy, dual therapy is effective and safe in patients with recent ischaemic heart disease, ischaemic stroke, and TIA. However, the balance between safety (increased bleeding) and efficacy (reduced recurrence) remains unclear when given chronically to patients with prior ischaemic stroke or TIA.
Methods: Completed randomised controlled trials comparing dual versus mono antiplatelet therapy in patients with prior ischaemic stroke or TIA were searched for electronically (Cochrane Library, PubMed) and in the reference lists of identified publications. Outcomes included stroke (all, ischaemic, haemorrhagic), composite vascular, bleeding and death. Data were analysed using random effects models with Review Manager software.
Results: Eight completed trials were identified, these including 48,650 patients. In comparison with monotherapy (aspirin, clopidogrel or dipyridamole), chronic dual antiplatelets (aspirin/clopidogrel, aspirin/dipyridamole, aspirin/vorapaxar) significantly reduced ischaemic stroke (odds ratio OR 0.87, 95% confidence intervals CI 0.77-0.97) and composite vascular events (OR 0.87, 95% CI 0.79-0.96 *), but increased intracranial haemorrhage (OR 1.38, 95% CI 1.00-1.90 *) and life threatening bleeding (trend: OR 1.39, 95% CI 0.99-1.97 *). Death did not differ (OR 1.00, 0.91- 1.10) between the antiplatelet regimens. * Heterogeneity was present in most analyses; the combination of aspirin and dipyridamole was not associated with increased bleeding.
Conclusions: Long-term use of dual antiplatelet therapy post stroke/TIA reduces further vascular events but increases intracranial haemorrhage. In view of the balance between benefit and hazard, the use of such treatment needs to be tailored to individual patients.
- © 2012 by American Heart Association, Inc.