title: Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Antiplatelets are recommended for patients with acute noncardioembolic stroke or transient ischemic attack. We compared the safety and efficacy of dual versus mono antiplatelet therapy in patients with acute ischemic stroke or transient ischemic attack.
  
  
  METHODS
  Completed randomized controlled trials of dual versus mono antiplatelet therapy in patients with acute (≤3 days) ischemic stroke/transient ischemic attack were identified using electronic bibliographic searches. The primary outcome was recurrent stroke (ischemic, hemorrhagic, unknown; fatal, nonfatal). Comparison of binary outcomes between treatment groups was analyzed with random effect models and described using risk ratios (95% CI).
  
  
  RESULTS
  Twelve completed randomized trials involving 3766 patients were included. In comparison with mono antiplatelet therapy, dual therapy (aspirin+dipyridamole and aspirin+clopidogrel) significantly reduced stroke recurrence, dual 58 (3.3%) versus mono 91 (5.0%; risk ratio, 0.67; 95% CI, 0.49-0.93); composite vascular event (stroke, myocardial infarction, vascular death), dual 74 (4.4%) versus mono 106 (6%; risk ratio, 0.75; 95% CI, 0.56-0.99); and the combination of stroke, transient ischemic attack, acute coronary syndrome, and all death, dual 100 (1.7%) versus mono 136 (9.1%; risk ratio, 0.71; 95% CI, 0.56-0.91); dual therapy was also associated with a nonsignificant trend to increase major bleeding, dual 15 (0.9%) versus mono 6 (0.4%; risk ratio, 2.09; 95% CI, 0.86-5.06).
  
  
  CONCLUSIONS
  Dual antiplatelet therapy appears to be safe and effective in reducing stroke recurrence and combined vascular events in patients with acute ischemic stroke or transient ischemic attack as compared with mono therapy. These results need to be tested in prospective studies.
authors.affiliation: Division of Stroke, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
authors.forename: Chamila M
authors.initials: CM
authors.lastname: Geeganage
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Christopher
authors.initials: C
authors.lastname: Chen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dengler
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Bath
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control*; D000077144:Clopidogrel; D016208:Databases, Factual; D004176:Dipyridamole / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D020521:Stroke; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin