Effect of addition of clopidogrel to aspirin on stroke incidence: Meta-analysis of randomized trials.

Abstract

BACKGROUND:

It remains controversial whether dual antiplatelet therapy reduces stroke more than aspirin alone.

AIM:

We aimed to assess the effects of adding clopidogrel to aspirin on the occurrence of stroke and major haemorrhage in patients with vascular disease.

METHODS:

Meta-analysis of published randomized trials comparing the combination of clopidogrel and aspirin vs. aspirin alone that reported stroke and major bleeding.

RESULTS:

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(2) index = 5%, P = 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.

CONCLUSIONS:

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.

• Authors: Santiago Palacio, Robert G Hart, Lesly A Pearce, David C Anderson, Mukul Sharma, Lee A Birnbaum, Oscar R Benavente
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 10 Issue 5 Pg. 686-91 (Jul 2015) ISSN: 1747-4949 [Electronic] United States
• PMID: 23692560 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Aged
• Aspirin (therapeutic use)
• Clopidogrel
• Drug Therapy, Combination
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Randomized Controlled Trials as Topic
• Stroke (drug therapy, epidemiology)
• Ticlopidine (analogs & derivatives, therapeutic use)