title: Long-Term Antiplatelet Mono- and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta-Analysis.
abstract: BACKGROUND
  The latest guidelines do not make clear recommendations on the selection of antiplatelet therapies for long-term secondary prevention of stroke. We aimed to integrate the available evidence to create hierarchies of the comparative efficacy and safety of long-term antiplatelet therapies after ischemic stroke or transient ischemic attack.
  
  
  RESULTS
  We performed a network meta-analysis of randomized controlled trials to compare 11 antiplatelet therapies in patients with ischemic stroke or transient ischemic attack. In December 2014, we searched Medline, Embase, and the Cochrane Library database for trials. The search identified 24 randomized controlled trials including a total of 85 667 patients with antiplatelet treatments for at least 1 year. Cilostazol significantly reduced stroke recurrence in comparison with aspirin (odds ratio 0.66, 95% credible interval 0.44 to 0.92) and dipyridamole (odds ratio 0.57, 95% credible interval 0.34 to 0.95), respectively. Cilostazol also significantly reduced intracranial hemorrhage compared with aspirin, clopidogrel, terutroban, ticlopidine, aspirin plus clopidogrel, and aspirin plus dipyridamole. Aspirin plus clopidogrel could not significantly reduce stroke recurrence compared with monotherapies but caused significantly more major bleeding than all monotherapies except terutroban. The pooled estimates did not change materially in the sensitivity analyses of the primary efficacy outcome.
  
  
  CONCLUSIONS
  Long-term monotherapy was a better choice than long-term dual therapy, and cilostazol had the best risk-benefit profile for long-term secondary prevention after stroke or transient ischemic attack. More randomized controlled trials in non-East Asian patients are needed to determine whether long-term use of cilostazol is the best option for the prevention of recurrent stroke.
authors: Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China (W.X.).
authors: Wuxiang
authors: W
authors: Xie
authors: Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China (F.Z.).
authors: Fanfan
authors: F
authors: Zheng
authors: Department of Psychiatry, University of Rochester Medical Center, New York, NY (B.Z.).
authors: Baoliang
authors: B
authors: Zhong
authors: Department of Biostatistics, Columbia University, New York, NY (X.S.).
authors: Xiaoyu
authors: X
authors: Song
mesh_terms: D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D016017:Odds Ratio; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet; network meta‐analysis; stroke; transient ischemic attack