Comparative efficacy and safety of different durations of dual antiplatelet therapy in acute minor non-cardioembolic stroke: a systematic review and network meta-analysis.

Background: International guidelines recommend short-course dual antiplatelet therapy (DAPT) for secondary prevention in patients with acute minor stroke. However, the optimal duration of such therapy remains unclear. This review aims to evaluate and compare the efficacy and safety of different DAPT durations in the secondary prevention of acute minor ischemic stroke.

Methods: The present study systematically searched PubMed, Embase (via Ovid), Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and ClinicalTrials.gov to identify relevant randomized-controlled trials. The primary outcome was the incidence of all recurrent strokes. Data synthesis was performed through network meta-analysis and paired meta-analysis methodologies.

Results: A total of 7 studies with 34,646 participants were included. Compared with aspirin alone, each course of DAPT reduced the risk of recurrent stroke but increased the risk of bleeding: aspirin-clopidogrel 21 day DAPT (OR 0.75,95% CI 0.66-0.85)/(OR 1.48, 95% CI 1.16-1.89); aspirin-ticagrelor 30 day DAPT (OR 0.81,95% CI 0.70-0.95)/(OR 3.98,95% CI 1.74-9.10); aspirin-clopidogrel 90 day DAPT (OR 0.75,95% CI 0.60-0.93)/(OR 2.02, 95% CI 1.42-2.88). Compared with aspirin-clopidogrel 21 day DAPT, aspirin-ticagrelor 21 day DAPT was more efficacious with an increased risk of bleeding (OR 0.78,95% CI 0.65-0.92)/(OR 1.86, 95% CI 1.39-2.49). Network meta-analysis showed that aspirin-clopidogrel 21 day DAPT had the best risk-benefit profile, followed by aspirin-ticagrelor 21 day DAPT and aspirin-clopidogrel 90 day DAPT, with aspirin alone being the least effective.

Conclusions: The risk-benefit profile of 21 day DAPT with aspirin-clopidogrel was superior to that of other short-course DAPTs.