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

Research output: Contribution to journalArticle

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; P2=28%) and of ischemic stroke or transient ischemic attack by 23% (RR, 0.77; 95% CI, 0.69-0.85; P2=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; P2=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.

Original languageEnglish (US)
Pages (from-to)492-503
Number of pages12
JournalStroke
Volume45
Issue number2
DOIs
StatePublished - Feb 2014

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clopidogrel
Vascular Diseases
Aspirin
Meta-Analysis
Stroke
Therapeutics
Intracranial Hemorrhages
Odds Ratio
Transient Ischemic Attack
Confidence Intervals
Risk Reduction Behavior
Secondary Prevention
MEDLINE
Cardiovascular Diseases
Safety

Keywords

  • Antiplatelet agents
  • Intracranial hemorrhages
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Gouya, G., Arrich, J., Wolzt, M., Huber, K., Verheugt, F. W. A., Gurbel, P. A., ... Siller-Matula, J. M. (2014). Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases: A systematic review and meta-analysis. Stroke, 45(2), 492-503. https://doi.org/10.1161/STROKEAHA.113.002590

Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases : A systematic review and meta-analysis. / Gouya, Ghazaleh; Arrich, Jasmin; Wolzt, Michael; Huber, Kurt; Verheugt, Freek W A; Gurbel, Paul A.; Pirker-Kees, Agnes; Siller-Matula, Jolanta M.

In: Stroke, Vol. 45, No. 2, 02.2014, p. 492-503.

Research output: Contribution to journalArticle

Gouya, G, Arrich, J, Wolzt, M, Huber, K, Verheugt, FWA, Gurbel, PA, Pirker-Kees, A & Siller-Matula, JM 2014, 'Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases: A systematic review and meta-analysis', Stroke, vol. 45, no. 2, pp. 492-503. https://doi.org/10.1161/STROKEAHA.113.002590
Gouya, Ghazaleh ; Arrich, Jasmin ; Wolzt, Michael ; Huber, Kurt ; Verheugt, Freek W A ; Gurbel, Paul A. ; Pirker-Kees, Agnes ; Siller-Matula, Jolanta M. / Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases : A systematic review and meta-analysis. In: Stroke. 2014 ; Vol. 45, No. 2. pp. 492-503.
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