Effect of addition of clopidogrel to aspirin on stroke incidence: Meta‐analysis of randomized trials. Issue 5 (22nd May 2013)

• Record Type: Journal Article
• Authors: Palacio, Santiago; Hart, Robert G.; Pearce, Lesly A.; Anderson, David C.; Sharma, Mukul; Birnbaum, Lee A.; Benavente, Oscar R.
• Is Part Of: International journal of stroke. Volume 10:Issue 5(2015:Jul.)
• Page Start: 686
• Page End: 691
• Publication Date: 2013-05-22
• Subjects: 616.8005
• DOI: 10.1111/ijs.12050
• Languages: English
• ISSNs: 1747-4930

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ijs12050-sec-0001" sec-type="section"> <title>Background</title> <p>It remains controversial whether dual antiplatelet therapy reduces stroke more than aspirin alone.</p> </sec> <sec id="ijs12050-sec-0002" sec-type="section"> <title>Aim</title> <p>We aimed to assess the effects of adding clopidogrel to aspirin on the occurrence of stroke and major haemorrhage in patients with vascular disease.</p> </sec> <sec id="ijs12050-sec-0003" sec-type="section"> <title>Methods</title> <p>Meta‐analysis of published randomized trials comparing the combination of clopidogrel and aspirin vs. aspirin alone that reported stroke and major bleeding.</p> </sec> <sec id="ijs12050-sec-0004" sec-type="section"> <title>Results</title> <p>Thirteen randomized trials were included with a total of 90 433 participants (mean age 63 years; 63% male) with a mean follow‐up of 1·0 years and 2011 strokes. Stroke was reduced 19% by dual antiplatelet therapy (odds ratio = 0·81, 95% confidence interval 0·74–0·89) with no evidence of heterogeneity of effect across different trial populations (I<sup>2</sup> index = 5%, <italic>P</italic> = 0·4 for heterogeneity). Dual antiplatelet therapy reduced ischemic stroke by 23% (odds ratio = 0·77; 95% confidence interval 0·70–0·85); there was a nonsignificant 12% increase in intracerebral haemorrhage (odds ratio = 1·12, 95% confidence interval 0·86–1·46). Among 1930 participants with recent (<30 days) brain ischemia from four trials, stroke was reduced by 33% (odds ratio = 0·67, 95% confidence interval 0·46–0·97) by dual antiplatelet therapy vs. aspirin alone. The risk of major bleeding was increased by 40% (odds ratio = 1·40, 95% confidence interval 1·26–1·55) by dual antiplatelet therapy.</p> </sec> <sec id="ijs12050-sec-0005" sec-type="section"> <title>Conclusions</title> <p>This meta‐analysis demonstrates a substantial relative risk reduction in stroke by clopidogrel plus aspirin vs. aspirin alone that is consistent across different trial cohorts. Major haemorrhage is increased by dual antiplatelet therapy.</p> </sec> </abstract>