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Short-term DAPT may reduce subsequent strokes compared with aspirin alone
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Dual antiplatelet therapy with clopidogrel and aspirin given within 24 hours after high-risk transient ischemic attack or minor ischemic stroke can reduce subsequent strokes, according to findings published in The BMJ.
The study, conducted by Qiukui Hao, MD, of the Center of Gerontology and Geriatrics at West China Hospital, Sichuan University in China, and colleagues, was a systematic review and meta-analysis of randomized placebo-controlled trials including CHANCE and POINT.
“Clinical trials and meta-analyses have shown that patients who experience minor ischemic strokes or TIAs benefit from antiplatelet therapy,” Hao and colleagues wrote. “Consequently, current guidelines for the management of acute ischemic stroke and TIA recommend antiplatelet therapy — typically providing strong recommendations for use of a single agent, most commonly aspirin.”
The analysis included 10,447 participants from three trials, with the primary outcome being a reported incidence of nonfatal recurring stroke.
Hao and colleagues identified that DAPT implemented with 24 hours of symptom onset reduced nonfatal recurrent stroke (RR = 0.7; 95% CI, 0.61-0.8) with an absolute risk reduction of 1.9% and no apparent impact on all-cause mortality (RR = 1.27; 95% CI, 0.73-2.23), but there was a numerical increase in moderate or severe extracranial bleeding (RR = 1.71; 95% CI, 0.92-3.2; absolute risk increase, 0.2%).
The researchers identified that most strokes occurred within 10 days of randomization and the incidence curves separated between the groups during that time, but any benefits from DAPT appear to be restricted to the first 21 days.
The evidence from their study has important implications for the duration of DAPT, Hao and colleagues wrote.
“The findings of this research paper raise questions about how the dual antiplatelet therapy should be used in clinical practice,” Hao and colleagues wrote. – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
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