Abstract 4138076: Clopidogrel plus aspirin vs. aspirin alone in patients with minor to moderate strokes within ≤ 72 hours onset. A meta-analysis of randomized controlled trials.

Background&Objective: Recurrent stroke is a common event following a previous transient ischemic attack (TIA) or minor to moderate ischemic stroke. Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin monotherapy. We aim to study the effects on using DAPT vs. aspirin alone in patients with TIAs or mild to moderate ischemic strokes within 72 hours of symptoms. Methods: We conducted a meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochran. We used mean difference (MD) to pool continuous outcomes presented and the risk ratio (RR) for the dichotomous outcomes, with the corresponding 95% confidence interval (CI). Results: We included seven RCTs with a total of 20,992 patients. DAPT was more effective in reducing combined ischemic and hemorrhagic strokes recurrence (RR = 0.77, 95% CI (0.70, 0.84), P < 0.00001) Fig-A , ischemic strokes (RR = 0.74, 95% CI (0.67, 0.82), P < 0.00001) Fig-B , early neurologic deterioration (RR= 0.46, 95% CI (0.24, 0.88), P = 0.04) Fig-C , poor functional outcome (RR = 0.89, 95% CI (0.81, 0.98), P = 0.02) Fig-D , and composite of ischemic stroke, myocardial infarction, death from ischemic vascular causes, and major hemorrhage [RR = 0.80, 95% CI (0.73, 0.88), P < 0.00001] Fig-E . However, DAPT led to more bleeding events occurrence (RR = 1.74, 95% CI (1.23, 2.48), P = 0.002) Fig-F . Conclusion: DAPT is a viable option for stroke recurrence prevention, leading to better functional outcomes, and less early neurologic deterioration; however, it increases the overall bleeding.