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Original Contribution

Antiplatelet Treatment for Prevention of Cerebrovascular Events in Patients With Vascular Diseases

A Systematic Review and Meta-Analysis

Ghazaleh Gouya, Jasmin Arrich, Michael Wolzt, Kurt Huber, Freek W.A. Verheugt, Paul A. Gurbel, Agnes Pirker-Kees, Jolanta M. Siller-Matula
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https://doi.org/10.1161/STROKEAHA.113.002590
Stroke. 2013;STROKEAHA.113.002590
Originally published December 24, 2013
Ghazaleh Gouya
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Jasmin Arrich
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Michael Wolzt
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Kurt Huber
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Freek W.A. Verheugt
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Paul A. Gurbel
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Agnes Pirker-Kees
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Jolanta M. Siller-Matula
From the Departments of Clinical Pharmacology (G.G., M.W.), Emergency Medicine (J.A.), Neurology (A.P.-K.), and Cardiology (J.M.S.-M.), Medical University Vienna, Austria; 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria (K.H.); Department of Cardiology, University Hospital Nijmegen, Amsterdam, the Netherlands (F.W.A.V.); and Sinai Center for Thrombosis Research, Baltimore, MD (P.A.G.).
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Abstract

Background and Purpose—The efficacy and safety of different antiplatelet regimes for prevention of stroke in patients at high risk were investigated in a systematic review and meta-analysis.

Methods—We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science. Twenty-two studies comprising 173 371 patients were included.

Results—In the overall population, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in comparison to aspirin monotherapy reduced the relative risk of total stroke by 20% (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.73–0.88; P<0.0001; I2=28%) and of ischemic stroke or transient ischemic attack by 23% (RR, 0.77; 95% CI, 0.69–0.85; P<0.0001; I2=18%) without increasing the risk of intracranial hemorrhage. In the secondary prevention cohort, DAPT with aspirin and clopidogrel also reduced the relative risk of total stroke by 24% as compared with aspirin alone (RR, 0.76; 95% CI, 0.68–0.86; P<0.0001; I2=0%). DAPT with prasugrel or ticagrelor and aspirin versus DAPT with clopidogrel and aspirin was not associated with a risk reduction of stroke.

Conclusions—DAPT with clopidogrel and aspirin compared with aspirin effectively reduces the risk of total and ischemic stroke in the overall cohort consisting of patients with cardiovascular disease without increase in intracranial hemorrhage, as well as decreases the risk of a recurrent total stroke in patients with a previous stroke/transient ischemic attack. Our meta-analysis suggests that DAPT including low-dose aspirin (75–100 mg) and clopidogrel (75 mg) should be further investigated as a strategy to reduce recurrent strokes.

Clinical Trial Registration—URL: http://www.crd.york.ac.uk/prospero. Unique identifier: CRD42011001596.

  • antiplatelet agents
  • intracranial hemorrhages
  • stroke
  • Received June 24, 2013.
  • Revision received October 8, 2013.
  • Accepted November 5, 2013.
  • © 2013 American Heart Association, Inc.

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    Antiplatelet Treatment for Prevention of Cerebrovascular Events in Patients With Vascular Diseases
    Ghazaleh Gouya, Jasmin Arrich, Michael Wolzt, Kurt Huber, Freek W.A. Verheugt, Paul A. Gurbel, Agnes Pirker-Kees and Jolanta M. Siller-Matula
    Stroke. 2013;STROKEAHA.113.002590, originally published December 24, 2013
    https://doi.org/10.1161/STROKEAHA.113.002590

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    Antiplatelet Treatment for Prevention of Cerebrovascular Events in Patients With Vascular Diseases
    Ghazaleh Gouya, Jasmin Arrich, Michael Wolzt, Kurt Huber, Freek W.A. Verheugt, Paul A. Gurbel, Agnes Pirker-Kees and Jolanta M. Siller-Matula
    Stroke. 2013;STROKEAHA.113.002590, originally published December 24, 2013
    https://doi.org/10.1161/STROKEAHA.113.002590
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