Comparison of Effectiveness and Safety of Dual Antiplatelet Therapy (DAPT) With Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients With Mild-to-Moderate Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis.

Abstract

The aim of this meta-analysis was to assess the effectiveness and safety of the combination of clopidogrel and aspirin in patientswith mild ischemic stroke or transient ischemic attack (TIA).The methodologies employed in this meta-analysis strictly followed the commonly used reporting formats for systematic reviews and meta-analyses. The methodologies employed in this meta-analysis strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Until March 25, 2024, we conducted thorough searches on PubMed, EMBASE (Excerpta Medica Database), and the Cochrane Library to locate studies investigating the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with mild or moderate stroke or TIA. Outcomes assessed in this meta-analysis includedstroke (including ischemicstroke and hemorrhagic stroke), myocardial infarction, all bleeding events, and moderate to severe bleeding events. A total of 12 studies were included in this meta-analysis.The total number of enrolled patients across these studies was 35,369, with 16,957 receiving DAPT and 18,412 receiving aspirin monotherapy. Therisk of developing stroke was significantly lower in patients receiving the combination of clopidogrel and aspirin compared to the aspirin monotherapy group (relative risk (RR): 0.77, 95% confidence interval (CI): 0.72 to 0.83, p-value<0.0001). No significant differences were there in terms of all bleeding events(RR: 1.37, 95% CI: 0.92 to 2.04, p-value: 0.12) and moderate to severe bleeding events(RR: 1.18, 95% CI: 0.86 to 1.63, p-value: 0.30). These findings highlight the importance of carefully weighing the potential benefits against the risks, especially in clinical decision-making for patients with TIA or ischemic stroke. Further research is warranted to elucidate optimal strategies for balancing stroke prevention with bleeding risk mitigation in this patient population.