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Oral antiplatelet therapy for acute ischaemic stroke

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journal contribution
posted on 2022-02-10, 11:05 authored by Jatinder S Minhas, Tamara Chithiramohan, Xia Wang, Sam C Barnes, Rebecca H Clough, Meeriam Kadicheeni, Lucy C Beishon, Thompson Robinson
Background
In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long‐term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage.

Objectives
To assess the efficacy and safety of immediate oral antiplatelet therapy (i.e. started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke.

Search methods
We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, and two trials registers, and performed forward reference/cited reference searching in August 2020.

Selection criteria
Randomised controlled trials (RCTs) comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke.

Data collection and analysis
Two review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross‐checked the data. They assessed risk of bias of each study using the Risk of Bias 1 (RoB1) tool and overall certainty of the evidence for each outcome using the GRADE approach.

Main results
We included 11 studies involving 42,226 participants. Three new trials have been added since the last update (743 participants). As per the previous version of this review, two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 96% of the data. The risk of bias was low. The maximum follow‐up was six months. With treatment, there was a decrease in death or dependency at the end of follow‐up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99; 7 RCTs, 42,034 participants; moderate‐certainty evidence). For every 1000 people treated with aspirin, 13 people would avoid death or dependency (number needed to treat for an additional beneficial outcome 79).

Authors' conclusions
Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in people who cannot swallow) and started within 48 hours of onset of presumed ischaemic stroke, significantly decreased death and dependency, and reduced the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications; long‐term outcomes were improved.

History

Citation

Cochrane Database of Systematic Reviews, 2022, https://doi.org/10.1002/14651858.CD000029.pub4

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Cochrane Database of Systematic Reviews

Volume

2022

Issue

1

Publisher

Wiley

eissn

1465-1858

Acceptance date

2021-12-14

Copyright date

2022

Available date

2023-01-14

Language

en

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