Abstract
ObjectivesWhether clopidogrel should be added to aspirin for stroke prevention remained controversial for the risk of hemorrhagic complications. This meta-analysis was aimed to assess the efficacy and safety of adding clopidogrel to aspirin on stroke prevention in high vascular risk patients, and to provide evidence for a suitable duration of dual antiplatelet therapy.MethodsWe searched PubMed, EMBase, OVID and Cochrane Central Register of Controlled Trials (up to June, 2013) for randomized controlled trials evaluating the efficacy and safety of clopidogrel plus aspirin versus aspirin alone in high vascular risk patients. Comparisons of stroke and hemorrhagic complications between treatment groups were expressed by the pooled Relative Risks (RRs) with 95% Confidence Intervals (CIs).ResultsFifteen trials with a total of 97692 intention-to-treat participants were included with duration of follow-up ranging from 7 days to 3.6 years. Dual antiplatelet therapy reduced all stroke by 21% (RR: 0.79, 95% CI: 0.73–0.85) with no evidence of heterogeneity across the trials (P = 0.27, I 2 = 17%).The effects were consistent between short-term subgroup (≤1 month, RR: 0.76, 95% CI: 0.67–0.85) and long-term subgroup (≥3 months, RR: 0.81, 95% CI: 0.73–0.89). The risk of major bleeding was not significantly increased by dual antiplatelet therapy in short-term subgroup (RR: 1.11, 95% CI: 0.91–1.36), while significantly increased in long-term subgroup (RR: 1.52, 95% CI: 1.36–1.69). Long-term dual antiplatelet therapy substantially increased the risk of intracranial bleeding (RR: 1.76, 95% CI: 1.22–2.54).ConclusionsThis meta-analysis demonstrates that short-term combination of clopidogrel and aspirin is effective and safe for stroke prevention in high vascular risk patients. Long-term combination therapy substantially increases the risk of major bleeding and intracranial bleeding.
Highlights
Antiplatelet therapy has been recommended as the standard practice for stroke prevention in high vascular risk patients
The newly published Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial demonstrated that dual antiplatelet therapy for 21 days followed by clopidogrel for 3 months was safe and more effective than aspirin alone in preventing recurrence of stroke
Keywords, PubMed MeSH and free texts search were combined with the following keywords: clopidogrel, aspirin, Plavix, dual antiplatelet therapy, monotherapy, stroke, hemorrhage, hemorrhagic, RCTs, randomized controlled trial
Summary
Antiplatelet therapy has been recommended as the standard practice for stroke prevention in high vascular risk patients. Physicians have still been hesitating to give dual antiplatelet therapy to part of high vascular risk patients. The newly published Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial demonstrated that dual antiplatelet therapy for 21 days followed by clopidogrel for 3 months was safe and more effective than aspirin alone in preventing recurrence of stroke. We hypothesized that treatment duration of dual antiplatelets would have effect on the risk of hemorrhagic complications and one-month treatment would provide effective prevention on stroke and guarantee the safety
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
