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09-05-2024

Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis

Authors: Patricia Viana, Jessica Hoffmann Relvas, Thamiris Dias Delfino Cabral, Jorge Eduardo Persson, Artur Menegaz de Almeida, Marina Persson, Marcos Vinícius Oliveira Marques, Jamary Oliveira-Filho

Published in: Journal of Thrombosis and Thrombolysis

Abstract

The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are insufficiently established. Therefore, we aimed to perform a meta-analysis to compare DAPT with IV alteplase in patients with acute minor stroke. MEDLINE, Embase, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. Functional and safety outcomes in 90 days were analyzed. Statistical analysis was performed using Rstudio 4.3.1. Subanalyses were performed restricted to non-disabling minor strokes and NIHSS score ≤ 3. PROSPERO (CRD42023440986). We included five studies with a total of 6,340 patients, of whom 4,050 (63.9%) received DAPT. The follow-up period for all included studies was 90 days. There was no significant difference for individual outcomes of mRS 0–1 (OR 1.26; 95% CI 0.85–1.89; p = 0.25), mRS 0–2 (OR 0.99; 95% CI 0.69–1.43; p = 0.97), or all-cause mortality (OR 0.80; 95% CI 0.20–3.13; p = 0.75) between groups. Symptomatic intracranial hemorrhage (sICH) was significantly lower (OR 0.11; 95% CI 0.003–0.36; p < 0.001) in patients treated with DAPT compared with IV alteplase. In terms of mRS 0–1 and mRS 0–2, we found no significant difference in both subgroup analyses. We found no statistically significant difference between DAPT and IV alteplase regarding functional outcome (mRS scores of 0–1 and 0–2) or all-cause mortality at 90 days in patients with minor ischemic stroke. Additionally, DAPT was associated with a significantly lower rate of sICH.

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Title: Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis
Authors: Patricia Viana
Jessica Hoffmann Relvas
Thamiris Dias Delfino Cabral
Jorge Eduardo Persson
Artur Menegaz de Almeida
Marina Persson
Marcos Vinícius Oliveira Marques
Jamary Oliveira-Filho
Publication date: 09-05-2024
Publisher: Springer US
Published in: Journal of Thrombosis and Thrombolysis
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-024-02994-z

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