Efficacy of antiplatelet therapy for treating lacunar infarct: Meta-analysis

Q4 Medicine

中国现代神经疾病杂志 Pub Date : 2017-03-25 DOI:10.3969/CJCNN.V17I3.1560

Da Xu, Deng Chen, Lina Zhu, G. Tan, Haijiao Wang, Ling Liu

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Abstract

Objective To evaluate the efficacy of antiplatelet agents in secondary prevention of patients with lacunar infarct (LACI). Methods Retrieve relevant randomized controlled trials (RCTs) that reported antiplatelet therapy in patients with LACI from online databases (January 1, 1980-November 20, 2016) in PubMed, EMBASE/SCOPUS and Cochrane Online Library with key words: stroke, lacunar infarction, platelet aggregation inhibitors, antiplatelet, randomized controlled trial. Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions. All data were pooled by RevMan 5.3 software for Meta-analysis. A network Meta-analysis was done by R software Gemtc and JAGS software. Results A total of 4068 articles were enrolled and 12 high - quality RCTs (Jadad ≥ 4 scores) with 24 969 eligible participants were finally included after excluding duplicates and those not meeting the inclusion criteria. Meta-analysis showed single antiplatelet therapy was more effective than placebo in reducing ischemic stroke recurrence rate ( RR = 0.480, 95%CI: 0.300-0.780; P = 0.003) and any stroke recurrence rate ( RR = 0.780, 95%CI: 0.630-0.970; P = 0.030). The efficacy of single antiplatelet therapy was not significantly different from that of dual antiplatelet therapy (ischemic stroke recurrence rate: RR = 0.900, 95%CI: 0.760-1.050, P = 0.170; any stroke recurrence rate: RR = 0.910, 95%CI: 0.820-1.010, P = 0.070). Network Meta-analysis (four interventions including aspirin, placebo, cilostazol and ticlopidine) showed that cilostazol was associated with a significant reduction in recurrence of any stroke compared with aspirin ( OR = 0.341, 95% CrI: 0.011-0.673) and placebo ( OR = 0.615, 95% CrI: 0.191-1.042). Conclusions Single antiplatelet therapy could significantly reduce the recurrence of any stroke, especially ischemic stroke in patients with LACI. There is no evidence showing that dual antiplatelet therapy is probably better than single therapy. Cilostazol is better than aspirin in reducing any stroke recurrence in the treatment of LACI. DOI: 10.3969/j.issn.1672-6731.2017.03.004

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抗血小板治疗腔隙性梗死的疗效:meta分析

目的评价抗血小板药物对腔隙性梗死（LACI）患者的二次预防作用。方法从PubMed、EMBASE/SCOPUS和Cochrane在线图书馆的在线数据库（1980年1月1日至2016年11月20日）中检索报道LACI患者抗血小板治疗的相关随机对照试验（RCT），关键词为：中风、腔隙性梗死、血小板聚集抑制剂、抗血小板、随机对照试验。使用Jadad量表和Cochrane干预措施系统评价手册评估研究质量。所有数据均通过RevMan 5.3软件汇总，用于Meta分析。利用R软件Gemtc和JAGS软件进行网络元分析。结果共纳入4068篇文章，12项高质量随机对照试验（Jadad≥4分），24969名符合条件的参与者在排除重复和不符合纳入标准的参与者后最终被纳入。荟萃分析显示，单次抗血小板治疗在降低缺血性卒中复发率（RR=0.480，95%CI:0.300-0.780；P=0.003）和任何卒中复发率方面比安慰剂更有效（RR=0.780，95%CI:0.630-0.970；P=0.030）（缺血性卒中复发率：RR=0.900，95%CI:0.760-1.050，P=0.170；任何卒中复发率；RR=0.910，95%CI:0.820-1.010，P=0.070）。网络荟萃分析（包括阿司匹林、安慰剂、西洛他唑和噻氯匹定在内的四种干预措施）显示，与阿司匹林相比，西洛他zol与任何卒中复发的显著减少有关（OR=0.341，95%CI:0.011-0.673）结论单次抗血小板治疗可显著降低LACI患者任何脑卒中，尤其是缺血性脑卒中的复发率。没有证据表明双重抗血小板治疗可能比单一治疗更好。西洛他唑在减少LACI的任何中风复发方面优于阿司匹林。DOI:10.3969/j.issn.1672-6731017.03.004

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