title: Antiplatelet regimens in the long-term secondary prevention of transient ischaemic attack and ischaemic stroke: an updated network meta-analysis.
abstract: OBJECTIVE
  To examine the comparative efficacy and safety of different antiplatelet regimens in patients with prior non-cardioembolic ischaemic stroke or transient ischaemic attack.
  
  
  METHODS
  Systematic review and network meta-analysis.
  
  
  METHODS
  As on 31 March 2015, all randomised controlled trials that investigated the effects of antiplatelet agents in the long-term (≥ 3 months) secondary prevention of non-cardioembolic transient ischaemic attack or ischaemic stroke were searched and identified.
  
  
  METHODS
  The primary outcome measure of efficacy was serious vascular events (non-fatal stroke, non-fatal myocardial infarction and vascular death). The outcome measure of safety was any bleeding.
  
  
  RESULTS
  A total of 36 randomised controlled trials (82,144 patients) were included. Network meta-analysis showed that cilostazol was significantly more effective than clopidogrel (OR 0.77, 95% credible interval 0.60-0.98) and low-dose (75-162 mg daily) aspirin (0.69, 0.55-0.86) in the prevention of serious vascular events. Aspirin (50 mg daily) plus dipyridamole (400 mg daily) and clopidogrel reduced the risk of serious vascular events compared with low-dose aspirin; however, the difference was not statistically significant. Furthermore, low-dose aspirin was as effective as higher daily doses. Cilostazol was associated with a significantly lower bleeding risk than most of the other regimens. Moreover, aspirin plus clopidogrel was associated with significantly more haemorrhagic events than other regimens. Direct comparisons showed similar results as the network meta-analysis.
  
  
  CONCLUSIONS
  Cilostazol was significantly more effective than aspirin and clopidogrel alone in the long-term prevention of serious vascular events in patients with prior non-cardioembolic ischaemic stroke or transient ischaemic attack. Cilostazol was associated with a significantly lower bleeding risk than low-dose aspirin (75-162 mg daily) and aspirin (50 mg daily) plus dipyridamole (400 mg daily). Low-dose aspirin was as effective as higher daily doses. However, further large, randomised, controlled, head-to-head trials are needed, especially in non-Asian ethnic groups.
authors.affiliation: Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Peng-Peng
authors.initials: PP
authors.lastname: Niu
authors.affiliation: Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Zhen-Ni
authors.initials: ZN
authors.lastname: Guo
authors.affiliation: Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Jin
authors.affiliation: Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Ying-Qi
authors.initials: YQ
authors.lastname: Xing
authors.affiliation: Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077407:Cilostazol; D000077144:Clopidogrel; D004176:Dipyridamole / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006470:Hemorrhage; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D004176:Dipyridamole; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin
keywords: cerebral infarction; meta-analysis; platelet aggregation inhibitors; secondary prevention; transient ischemic attack