Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis
Aim. Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Cardiovascular Therapeutics |
| Online Access: | http://dx.doi.org/10.1155/2019/1607181 |
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| author | Maurizio Paciaroni Birsen Ince Bo Hu Jiann-Shing Jeng Kursad Kutluk Liping Liu Min Lou Vladimir Parfenov Ka Sing Lawrence Wong Babak Zamani Dara Paek Jung Min Han Michael del Aguila Shalini Girotra |
| author_facet | Maurizio Paciaroni Birsen Ince Bo Hu Jiann-Shing Jeng Kursad Kutluk Liping Liu Min Lou Vladimir Parfenov Ka Sing Lawrence Wong Babak Zamani Dara Paek Jung Min Han Michael del Aguila Shalini Girotra |
| author_sort | Maurizio Paciaroni |
| collection | DOAJ |
| description | Aim. Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to compare clopidogrel versus aspirin monotherapy in this population. Methods. PubMed, Embase, and CENTRAL databases were searched from inception to May 2018 to identify clinical trials and observational studies comparing clopidogrel versus aspirin for secondary prevention in patients with recent ischemic stroke within 12 months. Pooled effect estimates were calculated using a random effects model and were reported as risk ratios with 95% confidence intervals. Results. Five studies meeting eligibility criteria were included in the analysis. A total of 29,357 adult patients who had recent ischemic stroke received either clopidogrel (n=14,293) or aspirin (n=15,064) for secondary prevention. Pairwise meta-analysis showed a statistically significant risk reduction in the occurrence of major adverse cardiovascular and cerebrovascular events (risk ratio 0.72 [95% CI, 0.53–0.97]), any ischemic or hemorrhagic stroke (0.76 [0.58, 0.99), and recurrent ischemic stroke (0.72 [0.55, 0.94]) in patients who received clopidogrel versus aspirin. The risk of bleeding was also lower for clopidogrel versus aspirin (0.57 [0.45, 0.74]). There was no difference in the rate of all-cause mortality between the two groups. Conclusions. The analysis showed lower risks of major adverse cardiovascular or cerebrovascular events, recurrent stroke, and bleeding events for clopidogrel monotherapy compared to aspirin. These findings support clinical benefit for single antiplatelet therapy with clopidogrel over aspirin for secondary prevention in patients with recent ischemic stroke. |
| format | Article |
| id | doaj-art-48804921c97745e3b6e2af10badc81d1 |
| institution | Kabale University |
| issn | 1755-5914 1755-5922 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiovascular Therapeutics |
| spelling | doaj-art-48804921c97745e3b6e2af10badc81d12025-02-03T06:44:14ZengWileyCardiovascular Therapeutics1755-59141755-59222019-01-01201910.1155/2019/16071811607181Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-AnalysisMaurizio Paciaroni0Birsen Ince1Bo Hu2Jiann-Shing Jeng3Kursad Kutluk4Liping Liu5Min Lou6Vladimir Parfenov7Ka Sing Lawrence Wong8Babak Zamani9Dara Paek10Jung Min Han11Michael del Aguila12Shalini Girotra13Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, ItalyDepartment of Neurology, Division of Cerebrovascular Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, TurkeyUnion Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, ChinaStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanDepartment of Neurology, Dokuz Eylul University, Izmir, TurkeyDepartment of Neurology and Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaThe Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, ChinaDepartment of Nervous Diseases and Neurosurgery, Sechenov First Moscow State Medical University, Moscow, RussiaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong KongIranian Stroke Society, Tehran, IranDoctor Evidence, Santa Monica, CA, USADoctor Evidence, Santa Monica, CA, USADoctor Evidence, Santa Monica, CA, USASanofi, General Medicines and Emerging Markets, SingaporeAim. Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to compare clopidogrel versus aspirin monotherapy in this population. Methods. PubMed, Embase, and CENTRAL databases were searched from inception to May 2018 to identify clinical trials and observational studies comparing clopidogrel versus aspirin for secondary prevention in patients with recent ischemic stroke within 12 months. Pooled effect estimates were calculated using a random effects model and were reported as risk ratios with 95% confidence intervals. Results. Five studies meeting eligibility criteria were included in the analysis. A total of 29,357 adult patients who had recent ischemic stroke received either clopidogrel (n=14,293) or aspirin (n=15,064) for secondary prevention. Pairwise meta-analysis showed a statistically significant risk reduction in the occurrence of major adverse cardiovascular and cerebrovascular events (risk ratio 0.72 [95% CI, 0.53–0.97]), any ischemic or hemorrhagic stroke (0.76 [0.58, 0.99), and recurrent ischemic stroke (0.72 [0.55, 0.94]) in patients who received clopidogrel versus aspirin. The risk of bleeding was also lower for clopidogrel versus aspirin (0.57 [0.45, 0.74]). There was no difference in the rate of all-cause mortality between the two groups. Conclusions. The analysis showed lower risks of major adverse cardiovascular or cerebrovascular events, recurrent stroke, and bleeding events for clopidogrel monotherapy compared to aspirin. These findings support clinical benefit for single antiplatelet therapy with clopidogrel over aspirin for secondary prevention in patients with recent ischemic stroke.http://dx.doi.org/10.1155/2019/1607181 |
| spellingShingle | Maurizio Paciaroni Birsen Ince Bo Hu Jiann-Shing Jeng Kursad Kutluk Liping Liu Min Lou Vladimir Parfenov Ka Sing Lawrence Wong Babak Zamani Dara Paek Jung Min Han Michael del Aguila Shalini Girotra Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis Cardiovascular Therapeutics |
| title | Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_full | Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_fullStr | Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_short | Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_sort | benefits and risks of clopidogrel vs aspirin monotherapy after recent ischemic stroke a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2019/1607181 |
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