Abstract Details

Title Antiplatelet Therapy in Ischemic Stroke and Transient Ischemic Attack: A Network Meta-Analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-019

Objective

Our network meta-analysis (NMA) compared various antiplatelet therapies in ischemic stroke (IS) and transient ischemic attack (TIA) patients.

Background Antiplatelet therapy is the cornerstone of IS and TIA treatment. Studies have reported varied efficacy profiles of different antiplatelet regimens. However, the optimal antiplatelet regimen in patients with IS and TIA remains uncertain.

Design/Methods A comprehensive search of PubMed, Embase, and Cochrane was conducted to identify randomized controlled trials (RCTs) comparing various antiplatelet regimens in IS and TIA patients. Frequentist NMA was performed to evaluate the efficacy of these treatments in reducing early neurological deterioration (END) and mortality.

Results Our analysis included 36 RCTs involving 96,841 patients. Aspirin+clopidogrel (RR 0.10; 95% CI 0.04–0.25), aspirin+cilostazol (RR 0.11; 95% CI 0.04–0.29), aspirin (RR 0.16; 95% CI 0.07–0.35), cilostazol (RR 0.20; 95% CI 0.06–0.65), and tirofiban (RR 10.77; 95% CI 3.72–31.33) were all associated with a lower risk of END compared with placebo. Aspirin had a higher risk of mortality compared with aspirin + dipyridamole (RR 1.22; 95% CI 1.03–1.45). Aspirin+clopidogrel increased mortality compared with aspirin+dipyridamole (RR 1.40; 95% CI 1.11–1.77), clopidogrel (RR 1.26; 95% CI 1.03–1.54), and triflusal (RR 2.39; 95% CI 1.08–5.28). Ticagrelor had a higher mortality risk than triflusal (RR 2.44; 95% CI 1.03–5.76). In the p-score analysis, tirofiban had the highest probability of being the best treatment for reducing END, and triflusal for reducing mortality.

Conclusions Aspirin+clopidogrel, aspirin+cilostazol, aspirin, cilostazol, and tirofiban lowered END in patients with IS or TIA. Aspirin+clopidogrel increased mortality compared with aspirin+dipyridamole, clopidogrel, and triflusal. Tirofiban was found to be best in reducing END and triflusal for mortality.

Authors/Disclosures
Aisha Rizwan Ahmed, MBBS PRESENTER	Dr. Rizwan Ahmed has nothing to disclose.
Mrinal M. Murali Krishna, MBBS	Dr. Murali Krishna has nothing to disclose.
Meghna Joseph, MBBS	Dr. Joseph has nothing to disclose.
Paweł M. Łajczak	Mr. Lajczak has nothing to disclose.
Rabbia Jabbar, MBBS	Dr. Jabbar has nothing to disclose.
Rafael R. Oliveira	Mr. Oliveira has nothing to disclose.
Eshita Sharma	Miss Sharma has nothing to disclose.
Aishwarya Koppanatham, MBBS	Ms. Koppanatham has nothing to disclose.
Dikshit Chawla, MBBS	Mr. Chawla has nothing to disclose.
Yasmin P. Silva, MD	Dr. Silva has nothing to disclose.
Wajid M. Mir, MBBS	Dr. Mir has nothing to disclose.
Oguz Kagan Sahin, MD	Dr. Sahin has nothing to disclose.
Zeeshan Mansuri, MD, MBBS, DM, FSCAI	Dr. Mansuri has nothing to disclose.
Lubna Al-Sharif, MSc	Ms. Al-Sharif has nothing to disclose.
Maryam Rizwan, Lab scientist	Mrs. Rizwan has nothing to disclose.
Natalia Arturo, MD	Ms. Arturo has nothing to disclose.
Paweł Chochoł, MD	Mr. Chochol has nothing to disclose.
Thomas C. Varkey, MD (Banner University Medical Center)	Dr. Varkey has nothing to disclose.

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