Multiple versus fewer antiplatelet agents for preventing early recurrence a er ischaemic stroke or transient ischaemic attack

Abstract

Background

Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary

prevention of stroke, but the role of using multiple antiplatelet agents early a$er stroke or transient ischaemic attack (TIA) to improve

outcomes has not been established.

Objectives

To determine the eCectiveness and safety of initiating, within 72 hours a$er an ischaemic stroke or TIA, multiple antiplatelet agents versus

fewer antiplatelet agents to prevent stroke recurrence. The analysis explores the evidence for diCerent drug combinations.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched 6 July 2020), the Cochrane Central Register of Controlled Trials

(CENTRAL) (Issue 7 of 12, 2020) (last searched 6 July 2020), MEDLINE Ovid (from 1946 to 6 July 2020), Embase (1980 to 6 July 2020),

ClinicalTrials.gov, and the WHO ICTRP. We also searched the reference lists of identified studies and reviews and used the Science Citation

Index Cited Reference search for forward tracking of included studies.

Selection criteria

We selected all randomised controlled trials (RCTs) that compared the use of multiple versus fewer antiplatelet agents initiated within 72

hours a$er stroke or TIA.

Data collection and analysis

We extracted data from eligible studies for the primary outcomes of stroke recurrence and vascular death, and secondary outcomes of

myocardial infarction; composite outcome of stroke, myocardial infarction, and vascular death; intracranial haemorrhage; extracranial

haemorrhage; ischaemic stroke; death from all causes; and haemorrhagic stroke. We computed an estimate of treatment eCect and

performed a test for heterogeneity between trials. We analysed data on an intention-to-treat basis and assessed bias for all studies. We

rated the certainty of the evidence using the GRADE approach.