Dual antiplatelet therapy versus aspirin alone in acute ischemic stroke or transient ischemic attack: A meta-analysis and trial sequential analysis of randomized controlled trials.

Abstract

IntroductionData regarding the role of dual antiplatelet therapy in patients with ischemic stroke or transient ischemic attack are limited. This study aimed to systematically review and analyze the efficacy and safety of dual antiplatelet therapy compared with aspirin alone in patients with acute ischemic stroke or transient ischemic attack.MethodsWe searched PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception to August 2024 and identified randomized controlled trials comparing dual antiplatelet therapy with aspirin alone in patients with stroke. Pooled risk ratios with 95% confidence interval were calculated. Trial sequential analysis was conducted for the main outcomes to weigh the risks of type I and type II errors.ResultsFive studies involving 27,563 patients were included. Dual antiplatelet therapy was associated with a significantly reduced risk of recurrent ischemic stroke (risk ratio: 0.74, 95% confidence interval: 0.68-0.81) and major adverse cardiovascular events (risk ratio: 0.77, 95% confidence interval: 0.71-0.84). However, it was associated with a significantly higher risk of recurrent hemorrhagic stroke (risk ratio: 2.13, 95% confidence interval: 1.09-4.17) and bleeding (risk ratio: 2.21, 95% confidence interval: 1.48-3.32). Trial sequential analysis revealed that sufficient evidence for recurrent ischemic stroke, major adverse cardiovascular events, and bleeding was achieved.ConclusionDual antiplatelet therapy demonstrated a lower incidence of recurrent ischemic stroke and major adverse cardiovascular events compared with aspirin alone. However, further studies are warranted to provide sufficient evidence regarding recurrent hemorrhagic stroke and all-cause mortality.