Impact of dual antiplatelet therapy on patients with minor stroke after thrombolysis: a systematic review and meta-analysis

被引:0
作者
Hamayal, Muhammad [1 ]
Shahid, Warda [1 ]
Iftikhar, Iqra [1 ]
Siddiqui, Erum [2 ]
Sadiq, Najia [2 ]
Awwab, Muhammad [3 ]
Hafeez, Momina [1 ]
Nadeem, Muhammad Bilal [1 ]
Tahir, Muhammad Danyal [1 ]
机构
[1] Fed Med & Dent Coll, Islamabad, Pakistan
[2] Jinnah Sindh Med Univ, Karachi, Sindh, Pakistan
[3] Quaid Eazam Med Coll, Bahawalpur, Punjab, Pakistan
关键词
STROKE; CEREBROVASCULAR DISEASE; CLINICAL NEUROLOGY; TRANSIENT ISCHEMIC ATTACK; ASPIRIN PLUS CLOPIDOGREL; REOCCLUSION; ALTEPLASE; DURATION; SCALE;
D O I
10.1136/bmjno-2024-000957
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Intravenous thrombolysis for acute minor ischaemic strokes did not provide any benefit in the recent TEMPO-2 trial. In general, single antiplatelet agents are used to improve the outcomes after thrombolysis. This systematic review was done to assess the impact of dual antiplatelet therapy (DAPT) after thrombolysis in patients with minor stroke.Materials and methods A literature search was performed on PubMed, The Cochrane Library and Science Direct for articles between 2016 and 2024. All studies included patients with minor stroke, aged >= 18 years, National Institutes of Health Stroke Scale score of <= 5 (or 3) and those who received thrombolysis prior to DAPT. The primary endpoint was modified Rankin Scale (mRS) score of 0-1 at 90 days. The quality of the studies was assessed using the Newcastle Ottawa Scale. Risk ratios (RRs) were calculated, and subgroup analysis was done.Results Only 4 out of 4364 studies originally retrieved met the inclusion criteria and were included. The analysis showed that the mRS score improvement at 90 days was almost similar in both DAPT and single antiplatelet therapy (SAPT) groups (RR 1.09; 95% CI (0.98, 1.21), p=0.11). Risk of symptomatic intracranial haemorrhage (SICH) (RR 0.65; 95% CI (0.11, 3.97), p=0.64) and stroke recurrence (RR 0.88; 95% CI (0.44, 1.78), p=0.64) was reduced with DAPT compared with SAPT without any major significance.Conclusion While these findings could not establish the superiority of DAPT over SAPT, DAPT showed slightly better results in functional outcomes, reducing the risk of stroke recurrence and SICH after thrombolysis in patients with minor stroke.PROSPERO registration number CRD42024593717.
引用
收藏
页数:9
相关论文
共 37 条
[1]   Dual antiplatelet therapy versus intravenous tissue plasminogen activator with acute minor ischemic stroke: A systematic review and meta-analysis of safety and efficacy [J].
Abbas, Abdallah ;
Hamad, Abdullah Ashraf ;
Moawad, Mostafa Hossam El Din ;
Ewis, Dalia Kamal ;
Youssef, Rana Ahmed ;
Hamouda, Heba ;
Hassan, Malak A. ;
Aladawi, Mohammad ;
Elfil, Mohamed ;
Meshref, Mostafa ;
Al -Mufti, Fawaz .
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2024, 33 (07)
[2]   Early dual antiplatelet therapy in patients with minor ischemic stroke after intravenous thrombolysis [J].
Alet, Matias J. ;
Balcarce, Pilar ;
Ameriso, Sebastian F. .
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2024, 33 (10)
[3]   Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator [J].
Alexandrov, AV ;
Grotta, JC .
NEUROLOGY, 2002, 59 (06) :862-867
[4]   Dual Antiplatelet Therapy Improves Functional Outcome in Patients With Progressive Lacunar Strokes [J].
Berberich, Anne ;
Schneider, Christine ;
Reiff, Tilman ;
Gumbinger, Christoph ;
Ringleb, Peter Arthur .
STROKE, 2019, 50 (04) :1007-1009
[5]   European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke [J].
Berge, Eivind ;
Whiteley, William ;
Audebert, Heinrich ;
Marchis, Gian Marco De ;
Fonseca, Ana Catarina ;
Padiglioni, Chiara ;
Ossa, Natalia Perez de la ;
Strbian, Daniel ;
Tsivgoulis, Georgios ;
Turc, Guillaume .
EUROPEAN STROKE JOURNAL, 2021, 6 (01) :I-LXII
[6]   Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack Meta-Analysis of Randomized Controlled Trials [J].
Bhatia, Kirtipal ;
Jain, Vardhmaan ;
Aggarwal, Devika ;
Vaduganathan, Muthiah ;
Arora, Sameer ;
Hussain, Zeeshan ;
Uberoi, Guneesh ;
Tafur, Alfonso ;
Zhang, Cen ;
Ricciardi, Mark ;
Qamar, Arman .
STROKE, 2021, 52 (06) :e217-e223
[7]   Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials [J].
Broderick, Joseph P. ;
Adeoye, Opeolu ;
Elm, Jordan .
STROKE, 2017, 48 (07) :2007-2012
[8]   Efficacy and Safety of Aspirin for Primary Cardiovascular Risk Prevention in Younger and Older Age: An Updated Systematic Review and Meta-analysis of 173,810 Subjects from 21 Randomized Studies [J].
Calderone, Dario ;
Greco, Antonio ;
Ingala, Salvatore ;
Agnello, Federica ;
Franchina, Gabriele ;
Scalia, Lorenzo ;
Buccheri, Sergio ;
Capodanno, Davide .
THROMBOSIS AND HAEMOSTASIS, 2022, 122 (03) :445-455
[9]   Ischaemic stroke [J].
Campbell, Bruce C., V ;
De Silva, Deidre A. ;
Macleod, Malcolm R. ;
Coutts, Shelagh B. ;
Schwamm, Lee H. ;
Davis, Stephen M. ;
Donnan, Geoffrey A. .
NATURE REVIEWS DISEASE PRIMERS, 2019, 5 (1)
[10]   Clopidogrel with Aspirin versus Aspirin Alone following Intravenous Thrombolysis in Minor Stroke: A 1-Year Follow-Up Study [J].
Cao, Hai-Ming ;
Lian, Hui-Wen ;
E, Yan ;
Duan, Rui ;
Zhou, Jun-Shan ;
Chen, Xiang-Liang ;
Jiang, Teng .
BRAIN SCIENCES, 2023, 13 (01)