Abstract WMP6: Dual Antiplatelet Therapy versus Alteplase in Patients With Minor Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Minor stroke, defined as a National Institutes of Health Stroke Scale (NIHSS), score of less than or equal to 5, accountedfor half of Acute Ischemic Stroke (AIS) patients in 2019 . Given the low impairment on function, there is a debate about which therapy is better for these patients: intravenous alteplase or double antiplatelet therapy (DAPT).Research question: For patients with minor AIS who can be treated within 24 hours after symptom onset, is alteplase associated with better outcomes and a good safety profile? Methods: We systematically searched PubMed, Web of Science, and EMBASE. Outcomes of interest included: Modified Rankin Scale (mRS) 0-1, symptomatic intracranial hemorrhage (sICH) and stroke recurrence. Heterogeneity was examined with I2 statistics, and a random-effects model was used for all of the outcomes due to expected high heterogeneity. Results: We included 1 randomized controlled trial and 3 observational cohorts, comprising 2,224 patients. DAPT was administered to 1,395 (62.7%) patients. DAPT was associated with a significantly lower incidence of sICH (OR 0.21; 95% CI 0.05-0.83; P=0.03; Fig 1A). There was no significant difference between DAPT and alteplase in good clinical outcome (mRS 0-1) at 90 days (OR 1.19; 95% CI 0.67-2.11; P=0.55; Fig 1B) or stroke recurrence (OR 0.87; 95% CI 0.51-1.48; P=0.61; Fig 1C). Conclusion: In this systematic review and meta-analysis comparing alteplase and DAPT in patients with minor non-disabling acute stroke, DAPT was associated with lower risk of sICH and there was nodifference in excellent clinical outcome or stroke recurrence at 90 days.