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Long-term DAPT failed to benefit patients with ischemic stroke, TIA
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Dual antiplatelet therapy for more than 1 year after ischemic stroke or transient ischemic attack was not associated with greater reduction in risk for recurrent stroke or intracranial hemorrhage when compared with monotherapy.
Results of the new meta-analysis also demonstrated that long-term DAPT was associated with a higher risk for intracranial hemorrhage compared with use of long-term clopidogrel.
“Compared with clopidogrel monotherapy, long-term [DAPT] seemed to increase the risk for [intracranial hemorrhage] in persons with a prior ischemic stroke or TIA and does not further prevent recurrent ischemic events,” researchers wrote. “As such, long-term clopidogrel monotherapy may be a better choice than long-term [DAPT] for secondary stroke prevention among patients with ischemic stroke or TIA.”
The researchers analyzed results of seven randomized controlled trials involving 39,574 patients with a history of stroke or TIA. The trials compared DAPT and single antiplatelet therapy for at least 1 year and included recurrent stroke and intracranial hemorrhage as outcomes.
There was no difference in risk for recurrent stroke between those assigned DAPT and those assigned aspirin monotherapy (RR=0.89; 95% CI, 0.78-1.01) or those assigned clopidogrel monotherapy (RR=1.01; 95% CI, 0.93-1.08).
There was also no difference in risk for intracranial hemorrhage between patients assigned DAPT and patients assigned aspirin alone (RR=0.99; 95% CI, 0.7-1.42).
However, the researchers found a greater risk for intracranial hemorrhage in patients who received DAPT compared with patients who received clopidogrel alone (RR=1.46; 95% CI, 1.17-1.82).
The analysis also determined that DAPT increased major gastrointestinal bleeding compared with clopidogrel alone (risk difference, 3 more events per 1,000 patients). In addition, there was an association between DAPT and increased risk for intracerebral hemorrhage compared with clopidogrel (risk difference, 3 more events per 1,000 patients); however, the researchers determined that the quality of that evidence was moderate.
According to the researchers, these data do not exclude the potential benefits of short-term DAPT for acute stroke or TIA.
“Given the high early risk for stroke after TIA and ischemic stroke, a short course of [DAPT], such as aspirin plus clopidogrel, might be beneficial,” they wrote.
Disclosure: One researcher reports financial ties to Sanofi Korea. The other researchers report no relevant financial disclosures.
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