Article Commentary: “Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack”
Wern Yew Ding, MBChB
Bhatia K, Jain V, Aggarwal D, Vaduganathan M, Arora S, Hussain Z, Uberoi G, Tafur A, Zhang C, Ricciardi M, Qamar A. Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials. Stroke. 2021;52:e217–e223.
Transient ischemic attack (TIA)/cerebral vascular accident (CVA) and acute coronary syndrome share many similarities. An integral element to the management of patients with either condition includes the use of antiplatelet therapy to reduce the risk of recurrent events. In acute coronary syndrome, the administration of dual antiplatelet therapy (DAPT) has been established, while this is less certain in TIA/CVA. Recently, several trials have investigated this issue. In this meta-analysis by Bhatia and colleagues, they sought to compare the safety and efficacy of aspirin plus a P2Y12 inhibitor against aspirin alone for the prevention of recurrent stroke in patients with minor ischemic stroke or high-risk TIA.
The authors performed a thorough literature search to identify a total of 8,211 citations, of which, 4 were eventually included in this article with a total of 21,459 patients. Patients with presumed cardioembolic stroke, who received thrombolysis, were planned for endovascular therapy and had underlying indications for anticoagulation were excluded. Compared to aspirin alone, DAPT was associated with a lower risk of recurrent stroke (ischemic and hemorrhagic), major adverse cardiovascular event and recurrent ischemic event but with greater risk of major bleeding. There was no difference in the risk of hemorrhagic stroke or all-cause death between DAPT vs. aspirin alone. Overall, the authors surmised that current data supports the use of DAPT in patients with minor ischemic stroke or TIA.