title: Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis.
abstract: BACKGROUND
  Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA). We performed a meta-analysis of randomized, controlled trials evaluating dual versus mono antiplatelet therapy for acute noncardioembolic ischemic stroke or TIA.
  
  
  RESULTS
  We assessed randomized, controlled trials investigating dual versus mono antiplatelet therapy published up to November 2012 and the CHANCE trial (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), for efficacy and safety outcomes in adult patients with acute noncardioembolic ischemic stroke or TIA with treatment initiated within 3 days of ictus. In total, 14 studies of 9012 patients were included in the systematic review and meta-analysis. Dual antiplatelet therapy significantly reduced risk of stroke recurrence (risk ratio, 0.69; 95% confidence interval, 0.60-0.80; P<0.001) and the composite outcome of stroke, TIA, acute coronary syndrome, and all death (risk ratio, 0.71; 95% confidence interval, 0.63-0.81; P<0.001) when compared with monotherapy, and nonsignificantly increased risk of major bleeding (risk ratio, 1.35; 95% confidence interval, 0.70-2.59, P=0.37). Analyses restricted to the CHANCE Trial or the 7 double-blind randomized, controlled trials showed similar results.
  
  
  CONCLUSIONS
  For patients with acute noncardioembolic ischemic stroke or TIA, dual therapy was more effective than monotherapy in reducing risks of early recurrent stroke. The results of the CHANCE study are consistent with previous studies done in other parts of the world.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China (K.S.L.W., X.L., W.L.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., L.L., Y.W.); the Hong Kong Branch of the Chinese Cochrane Center, Division of Epidemiology, School of Public Health and Primary Care, Shatin, Hong Kong SAR, China (C.M., J.T.); the Stroke Trials Unit, University of Nottingham, Nottingham, UK (P.M.W.B.); the Stroke and Dementia Research Centre, St. George's, University of London, London, UK (H.S.M.); and the Department of Translational Science and Molecular Medicine, Michigan State University College of Medicine and Saint Mary's Health Care, Grand Rapids, MI (P.B.G.).
authors.forename: Ka Sing Lawrence
authors.initials: KS
authors.lastname: Wong
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xinyi
authors.initials: X
authors.lastname: Leng
authors.forename: Chen
authors.initials: C
authors.lastname: Mao
authors.forename: Jinling
authors.initials: J
authors.lastname: Tang
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.forename: Wenhua
authors.initials: W
authors.lastname: Lin
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet agents; meta-analysis; review, systematic; stroke; transient ischemic attack