Clopidogrel and Aspirin versus Aspirin Alone for Stroke Prevention: A Meta-Analysis.
OBJECTIVE
Antiplatelet therapy is widely used for the primary or secondary prevention of stroke. Drugs like clopidogrel have emerged as alternatives for traditional antiplatelet therapy, and dual therapy with clopidogrel and aspirin is of particular interest. We conducted this meta-analysis to systematically review studies about dual therapy comparing monotherapy with aspirin alone.


METHODS
Randomized controlled trials were searched in PubMed (1966-May, 2015), EMBASE (1947-May, 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (1948-May, 2015), WHO International Clinical Trial (ICTRP) (2004-May, 2015), China Biology Medicine disc (CBM disc) (1978-May, 2015) and were included into the final analysis according to the definite inclusion criteria mentioned in the study selection section. Risk ratio (RR) was pooled with 95% confidence interval (CI) for dichotomous data. The heterogeneity was considered significant if the χ2 test was significant (P value < 0.10) or the I2 > 50.00%. Subgroup analyses were carried out on the long and short time periods, the race and region.


RESULTS
We included 5 studies involving 24,084 patients. A pooled analysis showed that dual therapy with clopidogrel and aspirin had a lower stroke incidence than monotherapy in both the short term and long term (RR = 0.69, 95% CI: 0.59-0.82, P <0.05; RR = 0.84, 95% CI: 0.72-0.98, P = 0.03, respectively). With regard to safety, dual therapy had a higher risk of bleeding than monotherapy for both periods (RR = 1.51, 95% CI: 1.03-2.23, P = 0.04; RR = 1.54, 95% CI: 1.32-1.79, P<0.05, respectively).


CONCLUSIONS
Dual therapy with clopidogrel and aspirin could be a preferable choice to prevent stroke in patients who have had a previous stroke or transient ischemic attack, as well as those who are at high risk for stroke. And the effect of dual therapy seems to be more obvious for short-term. However, it is associated with a higher risk of bleeding.
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Shuai
S
Tan
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Xiaojuan
X
Xiao
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Hanyu
H
Ma
Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Zhaohui
Z
Zhang
Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Jiangbo
J
Chen
Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Lei
L
Ding
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Shenping
S
Yu
Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Rulin
R
Xu
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Shiliang
S
Yang
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Xinyi
X
Huang
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Hua
H
Hong
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D020521:Stroke / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin