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05.04.2024 | Review

Ticagrelor versus clopidogrel in dual antiplatelet therapy after minor stroke or transient ischemic attack: an updated network meta-analysis

verfasst von: Gabriel Marinheiro, Beatriz Araújo, Gabriel de Almeida Monteiro, Marianna Leite, Antonio Mutarelli, Artur Menegaz de Almeida, Joaquim Francisco Cavalcante-Neto, André Rivera, Agostinho C. Pinheiro, João Paulo Mota Telles

Erschienen in: Journal of Neurology

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Abstract

Background

Dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin is a well-established practice after a minor stroke or transient ischemic attack (TIA). However, ticagrelor plus aspirin may be an alternative.

Aims

We systematically searched PubMed, Embase, and Cochrane Central from inception to January 2024. We included randomized controlled trials (RCTs) enrolling adults with acute minor stroke or TIA within 72 hours of the onset of the symptoms.

Results

A total of 8 RCTs were included in our meta-analysis. Ticagrelor plus aspirin (RR, 0.70; 95% CrI 0.52, 0.91) and clopidogrel plus aspirin (RR, 0.79; 95% CrI 0.64, 0.98) were superior to aspirin in preventing stroke recurrence in overall analysis. Excluding studies with dual antiplatelet up to 90 days, ticagrelor plus aspirin was the only strategy that maintained superiority compared with aspirin regarding stroke recurrence (RR, 0.70; 95% CrI 0.51, 0.95) and ischemic stroke (RR, 0.68; 95% CrI 0.47, 0.94). There was no significant difference between treatment groups regarding hemorrhagic stroke, functional disability, and mortality.

Conclusions

DAPTs were superior to aspirin in preventing recurrence or ischemic stroke. Although no significant difference was observed between DAPTs, ticagrelor plus aspirin may be related to worse major bleeding results, including intracranial bleeding. Ticagrelor plus aspirin is a considerable option for patients after a minor stroke or TIA.

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Titel: Ticagrelor versus clopidogrel in dual antiplatelet therapy after minor stroke or transient ischemic attack: an updated network meta-analysis
verfasst von: Gabriel Marinheiro
Beatriz Araújo
Gabriel de Almeida Monteiro
Marianna Leite
Antonio Mutarelli
Artur Menegaz de Almeida
Joaquim Francisco Cavalcante-Neto
André Rivera
Agostinho C. Pinheiro
João Paulo Mota Telles
Publikationsdatum: 05.04.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-024-12330-3

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