title: Efficacy and safety of short-term dual- versus mono-antiplatelet therapy in patients with ischemic stroke or TIA: a meta-analysis of 10 randomized controlled trials.
abstract: Stroke is still a primary disease for death and disability all over the world. The optimal antiplatelet therapy for treatment of stroke is under controversy. We performed a meta-analysis to justify whether short-term (≤1 year) dual-antiplatelet therapy (DAPT) has advantages over mono-antiplatelet therapy. We systematically searched the databases of Cochrane library, Pubmed and Embase up to July 2016. Randomized controlled trials (RCTs) comparing DAPT with mono-antiplatelet therapy were included in our meta-analysis. Totally ten trials involving 8969 patients were satisfied with our inclusion criteria. At the end of follow-up, DAPT is associated with a significant reduction in recurrent stroke [risk ratio (RR) 0.65, 95 % confidence interval (CI) 0.56-0.76, P < 0.00001] and the net clinical outcome (ischemic stroke (IS) recurrence plus major bleeding) (RR 0.67, 95 % CI 0.58-0.79, P < 0.00001). In terms of safety outcomes of major bleeding (RR 1.44, 95 % CI 0.72-2.88, P = 0.30) and intracranial hemorrhage (RR 1.29, 95 % CI 0.56-2.93, P = 0.55), DAPT has a homologous safety profile compared with mono-antiplatelet therapy. The subgroup analysis according to different races, antiplatelet combinations or initiation time produced similar outcomes as comprehensive outcomes. Given short-term treatment regimen, DAPT can be superior to mono-antiplatelet therapy in treating IS or transient ischemic attack (TIA). No matter in acute or non-acute phase of IS, short-term DAPT has more efficacy than mono-antiplatelet therapy and has equivalent safety as mono-antiplatelet therapy.
authors.affiliation: Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Neurology, General Hospital of Shenyang Military Area, 83 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China.
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Fei
authors.affiliation: Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China.
authors.forename: Jingxue
authors.initials: J
authors.lastname: Fang
authors.affiliation: Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China.
authors.forename: Meijuan
authors.initials: M
authors.lastname: Zou
authors.affiliation: Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning Province, China. chenggang63@hotmail.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Cheng
mesh_terms: D002545:Brain Ischemia / Q000150:complications; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet agents; Meta-analysis; Short term; Stroke; Transient ischemic attack