Comparative Efficacy and Safety of Nine Anti-Platelet Therapies for Patients with Ischemic Stroke or Transient Ischemic Attack: a Mixed Treatment Comparisons

Huang, Huapin; Lin, Wanhui; Chen, Shenggen; Chen, Lizhen; Chen, Minyi; Che, Chun‐Hui

doi:10.1007/s12035-016-9739-z

Cited by 7 publications

(14 citation statements)

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“…The combination of aspirin and dipyridamole emerged as the most effective regimen in preventing vascular events. Six further NMAs were published by Chinese authors between 2015 and 2019 [ 12 – 17 ]. Although minor differences in terms of included studies, five reviews agreed on suggesting that cilostazol is the most effective drug.…”

Section: Discussionmentioning

confidence: 99%

“…NMA also allows ranking drugs by benefits and harms [ 10 ], and thus are used in clinical guidelines to support recommendations [ 11 ]. Current NMA on antiplatelet drugs for secondary prevention of stroke focused only on a limited number of treatments and did not include a thorough assessment of the confidence in the estimates [ 12 – 17 ]. Therefore, we conducted a NMA to summarize the current evidence for using antiplatelet drugs for secondary prevention in adult patients with ischemic stroke or TIA by estimating their relative efficacy and safety and providing a clinically useful ranking to help clinicians in their daily practice as well as informed clinical guidelines’ development.…”

Section: Introductionmentioning

confidence: 99%

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Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

et al. 2021

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Background Antiplatelet drugs may prevent recurrent ischemic events after ischemic stroke but their relative effectiveness and harms still need to be clarified. Within this network meta-analysis we aimed to summarize the current evidence for using antiplatelet drugs for secondary stroke prevention. Methods We searched MEDLINE, EMBASE and CENTRAL up to September 2020. Randomized controlled trials (RCTs) assessing antiplatelet drugs for secondary stroke prevention were included. We did pairwise meta-analyses and network meta-analyses using random-effects models. Primary outcomes were all strokes (ischemic or hemorrhagic) and all-cause mortality. Results The review included 57 RCTs, 50 (n = 165,533 participants) provided data for the meta-analyses. Compared to placebo/no treatment, moderate to high-confidence evidence indicated that cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day significantly reduced the risk of all strokes (odds ratios, ORs and absolute risk difference, ARD): cilostazol 0.51 (95 % confidence interval, CI, 0.37 to 0.71; 3.6 % fewer), clopidogrel 0.63 (95 % CI, 0.49 to 0.79; 2.7 % fewer), dipyridamole + aspirin 0.65 (95 % CI, 0.55 to 0.78; 2.5 % fewer), ticagrelor 0.68 (95 % CI, 0.50 to 0.93; 2.3 % fewer), ticlopidine 0.74 (95 % CI 0.59 to 0.93; 1.9 % fewer), aspirin ≤ 150 mg/day 0.79 (95 % CI, 0.66 to 0.95; 1.5 % fewer). Aspirin > 150 mg/day and the combinations clopidogrel/aspirin, ticagrelor/aspirin, also decrease all strokes but increase the risk of hemorrhagic events. Only aspirin > 150 mg/day significantly reduced all-cause mortality (OR 0.86, 95 % CI 0.76 to 0.97; ARD 0.9 %, 95 %CI 1.5–0.2 % fewer, moderate confidence). Compared to aspirin ≤ 150 mg/day, clopidogrel significantly reduced the risk of all strokes, cardiovascular events, and intracranial hemorrhage outcomes. Cilostazol also appeared to provide advantages but data are limited to the Asian population. Conclusions Considering the benefits and harms ratio, cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day appear to be the best choices as antiplatelet drugs for secondary prevention of patients with ischemic stroke or TIA. Systematic review registration PROSPERO CRD42020159896.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

et al. 2021

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“…By contrast, trials from the Management of Atherothrombosis with Clop in High‐Risk Patients (MATCH) suggested that the introduction of neither Clop nor ASA could enhance the effectiveness of preventing secondary ischemic strokes compared with the monotherapy . Also, the risk of recurrent strokes in patients treated by ASA plus DP was not significantly different from the risk of those treated by Clop monotherapy . Based on previous findings, there were growing interests in comparing mono and dual antiplatelet therapies for preventing ischemic strokes or TIAs.…”

Section: Introductionmentioning

confidence: 99%

“…Based on previous findings, there were growing interests in comparing mono and dual antiplatelet therapies for preventing ischemic strokes or TIAs. As a result, several pair‐wise meta‐analyses have been designed to enhance the corresponding evidence with respect to the relative efficacy and safety of different antiplatelet agents . However, selecting an appropriate antiplatelet medication for patients was a challenging dilemma when both the efficacy and safety should be taken into account.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, several pair-wise meta-analyses have been designed to enhance the corresponding evidence with respect to the relative efficacy and safety of different antiplatelet agents. 2,[12][13][14][15][16] However, selecting an appropriate antiplatelet medication for patients was a challenging dilemma when both the efficacy and safety should be taken into account. For this purpose, we performed a mixed treatment comparison meta-analysis by incorporating both direct and indirect evidence from clinical trials.…”

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Comparative efficacy and safety of antiplatelet agents in cerebral ischemic disease: A network meta‐analysis

Zhu

Long

2019

J of Cellular Biochemistry

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We performed this network meta-analysis (NMA) to enhance the corresponding evidence of the relative efficacy and safety of different anti-platelet agents in cerebral ischemic disease. PubMed and EMBASE were searched systematically for relevant studies. Outcomes were compared using odds ratios (ORs) and 95% credible intervals (CrI). Each agent was ranked according to the value of surface under the cumulative ranking curve (SUCRA). Publication bias was evaluated by funnel plots while consistency between direct and indirect comparison was analyzed by node splitting and heat plots. Besides, clustering technique was used to categorize similar agents. A number of 44 eligible studies with 148578 patients were included in this NMA. In terms of efficacy (including mortality, recurrent stroke and vascular event), all six interventions were better than placebo. clopidogrel (Clop) and aspirin (ASA)+Clop were the best two interventions from SUCRA. However, the performance of ASA+Clop declined significantly when considering safety (including myocardial infarction, all-cause withdrawal and intracranial hemorrhage), especially worse in intracranial hemorrhage. In conclusion, Clop was potentially the most preferable treatment for preventing cerebral ischemic in terms of efficacy and safety. However, the addition of ASA was associated with a potential increase in intracranial hemorrhage, therefore, combination therapy of ASA and Clop should be introduced with caution despite it may be more effective than the monotherapy of ASA. This article is protected by copyright. All rights reserved.

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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

et al. 2016

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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.

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Comparative Efficacy and Safety of Nine Anti-Platelet Therapies for Patients with Ischemic Stroke or Transient Ischemic Attack: a Mixed Treatment Comparisons

Cited by 7 publications

References 50 publications

Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

Comparative efficacy and safety of antiplatelet agents in cerebral ischemic disease: A network meta‐analysis

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

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