Efficacy of Antiplatelet Therapy in Secondary Prevention Following Lacunar Stroke: Pooled Analysis of Randomized Trials

Chun Shing Kwok, Ashkan Shoamanesh, Hannah Charlotte Copley, Phyo Kyaw Myint, Yoon K Loke, Oscar R Benavente

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Lacunar stroke accounts for ≈25% of ischemic stroke, but optimal antiplatelet regimen to prevent stroke recurrence remains unclear. We aimed to evaluate the efficacy of antiplatelet agents in secondary stroke prevention after a lacunar stroke.

METHODS: We searched MEDLINE, Embase, and the Cochrane library for randomized controlled trials that reported risk of recurrent stroke or death with antiplatelet therapy in patients with lacunar stroke. We used random effects meta-analysis and evaluated heterogeneity with I(2).

RESULTS: We included 17 trials with 42 234 participants (mean age 64.4 years, 65% male) and follow up ranging from 4 weeks to 3.5 years. Compared with placebo, any single antiplatelet agent was associated with a significant reduction in recurrence of any stroke (risk ratio [RR] 0.77, 0.62-0.97, 2 studies) and ischemic stroke (RR 0.48, 0.30-0.78, 2 studies), but not for the composite outcome of any stroke, myocardial infarction, or death (RR 0.89, 0.75-1.05, 2 studies). When other antiplatelet agents (ticlodipine, cilostazol, and dipyridamole) were compared with aspirin, there was no consistent reduction in stroke recurrence (RR 0.91, 0.75-1.10, 3 studies). Dual antiplatelet therapy did not confer clear benefit over monotherapy (any stroke RR 0.83, 0.68-1.00, 3 studies; ischemic stroke RR 0.80, 0.62-1.02, 3 studies; composite outcome RR 0.90, 0.80-1.02, 3 studies).

CONCLUSIONS: Our results suggest that any of the single antiplatelet agents compared with placebo in the included trials is adequate for secondary stroke prevention after lacunar stroke. Dual antiplatelet therapy should not be used for long-term stroke prevention in this stroke subtype.

Original languageEnglish
Pages (from-to)1014-1023
Number of pages10
JournalStroke
Volume46
Issue number4
Early online date26 Feb 2015
DOIs
Publication statusPublished - Apr 2015

Fingerprint

Lacunar Stroke
Secondary Prevention
Stroke
Odds Ratio
Platelet Aggregation Inhibitors
Therapeutics
Recurrence
Placebos
Dipyridamole
MEDLINE
Aspirin
Libraries
Meta-Analysis

Keywords

  • antiplatelet agent
  • aspirin
  • lacunar stroke
  • mortality
  • stroke

Cite this

Efficacy of Antiplatelet Therapy in Secondary Prevention Following Lacunar Stroke : Pooled Analysis of Randomized Trials. / Kwok, Chun Shing; Shoamanesh, Ashkan; Copley, Hannah Charlotte; Myint, Phyo Kyaw; Loke, Yoon K; Benavente, Oscar R.

In: Stroke, Vol. 46, No. 4, 04.2015, p. 1014-1023.

Research output: Contribution to journalArticle

Kwok, Chun Shing ; Shoamanesh, Ashkan ; Copley, Hannah Charlotte ; Myint, Phyo Kyaw ; Loke, Yoon K ; Benavente, Oscar R. / Efficacy of Antiplatelet Therapy in Secondary Prevention Following Lacunar Stroke : Pooled Analysis of Randomized Trials. In: Stroke. 2015 ; Vol. 46, No. 4. pp. 1014-1023.
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abstract = "BACKGROUND AND PURPOSE: Lacunar stroke accounts for ≈25{\%} of ischemic stroke, but optimal antiplatelet regimen to prevent stroke recurrence remains unclear. We aimed to evaluate the efficacy of antiplatelet agents in secondary stroke prevention after a lacunar stroke.METHODS: We searched MEDLINE, Embase, and the Cochrane library for randomized controlled trials that reported risk of recurrent stroke or death with antiplatelet therapy in patients with lacunar stroke. We used random effects meta-analysis and evaluated heterogeneity with I(2).RESULTS: We included 17 trials with 42 234 participants (mean age 64.4 years, 65{\%} male) and follow up ranging from 4 weeks to 3.5 years. Compared with placebo, any single antiplatelet agent was associated with a significant reduction in recurrence of any stroke (risk ratio [RR] 0.77, 0.62-0.97, 2 studies) and ischemic stroke (RR 0.48, 0.30-0.78, 2 studies), but not for the composite outcome of any stroke, myocardial infarction, or death (RR 0.89, 0.75-1.05, 2 studies). When other antiplatelet agents (ticlodipine, cilostazol, and dipyridamole) were compared with aspirin, there was no consistent reduction in stroke recurrence (RR 0.91, 0.75-1.10, 3 studies). Dual antiplatelet therapy did not confer clear benefit over monotherapy (any stroke RR 0.83, 0.68-1.00, 3 studies; ischemic stroke RR 0.80, 0.62-1.02, 3 studies; composite outcome RR 0.90, 0.80-1.02, 3 studies).CONCLUSIONS: Our results suggest that any of the single antiplatelet agents compared with placebo in the included trials is adequate for secondary stroke prevention after lacunar stroke. Dual antiplatelet therapy should not be used for long-term stroke prevention in this stroke subtype.",
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note = "{\circledC} 2015 American Heart Association, Inc. Acknowledgements C.S. Kwok and A. Shoamanesh was involved in design, screening, study selection, data extraction, data analysis, and preparation of article. H.C. Copley was involved in screening and data extraction. P.K. Myint was involved in the design, screening, and preparation of the article. Y.K. Loke was involved in the design, study selection, data extractions, data analysis, and preparation of the article. O.R. Benavente was involved in design and preparation of the article.",
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T1 - Efficacy of Antiplatelet Therapy in Secondary Prevention Following Lacunar Stroke

T2 - Pooled Analysis of Randomized Trials

AU - Kwok, Chun Shing

AU - Shoamanesh, Ashkan

AU - Copley, Hannah Charlotte

AU - Myint, Phyo Kyaw

AU - Loke, Yoon K

AU - Benavente, Oscar R

N1 - © 2015 American Heart Association, Inc. Acknowledgements C.S. Kwok and A. Shoamanesh was involved in design, screening, study selection, data extraction, data analysis, and preparation of article. H.C. Copley was involved in screening and data extraction. P.K. Myint was involved in the design, screening, and preparation of the article. Y.K. Loke was involved in the design, study selection, data extractions, data analysis, and preparation of the article. O.R. Benavente was involved in design and preparation of the article.

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N2 - BACKGROUND AND PURPOSE: Lacunar stroke accounts for ≈25% of ischemic stroke, but optimal antiplatelet regimen to prevent stroke recurrence remains unclear. We aimed to evaluate the efficacy of antiplatelet agents in secondary stroke prevention after a lacunar stroke.METHODS: We searched MEDLINE, Embase, and the Cochrane library for randomized controlled trials that reported risk of recurrent stroke or death with antiplatelet therapy in patients with lacunar stroke. We used random effects meta-analysis and evaluated heterogeneity with I(2).RESULTS: We included 17 trials with 42 234 participants (mean age 64.4 years, 65% male) and follow up ranging from 4 weeks to 3.5 years. Compared with placebo, any single antiplatelet agent was associated with a significant reduction in recurrence of any stroke (risk ratio [RR] 0.77, 0.62-0.97, 2 studies) and ischemic stroke (RR 0.48, 0.30-0.78, 2 studies), but not for the composite outcome of any stroke, myocardial infarction, or death (RR 0.89, 0.75-1.05, 2 studies). When other antiplatelet agents (ticlodipine, cilostazol, and dipyridamole) were compared with aspirin, there was no consistent reduction in stroke recurrence (RR 0.91, 0.75-1.10, 3 studies). Dual antiplatelet therapy did not confer clear benefit over monotherapy (any stroke RR 0.83, 0.68-1.00, 3 studies; ischemic stroke RR 0.80, 0.62-1.02, 3 studies; composite outcome RR 0.90, 0.80-1.02, 3 studies).CONCLUSIONS: Our results suggest that any of the single antiplatelet agents compared with placebo in the included trials is adequate for secondary stroke prevention after lacunar stroke. Dual antiplatelet therapy should not be used for long-term stroke prevention in this stroke subtype.

AB - BACKGROUND AND PURPOSE: Lacunar stroke accounts for ≈25% of ischemic stroke, but optimal antiplatelet regimen to prevent stroke recurrence remains unclear. We aimed to evaluate the efficacy of antiplatelet agents in secondary stroke prevention after a lacunar stroke.METHODS: We searched MEDLINE, Embase, and the Cochrane library for randomized controlled trials that reported risk of recurrent stroke or death with antiplatelet therapy in patients with lacunar stroke. We used random effects meta-analysis and evaluated heterogeneity with I(2).RESULTS: We included 17 trials with 42 234 participants (mean age 64.4 years, 65% male) and follow up ranging from 4 weeks to 3.5 years. Compared with placebo, any single antiplatelet agent was associated with a significant reduction in recurrence of any stroke (risk ratio [RR] 0.77, 0.62-0.97, 2 studies) and ischemic stroke (RR 0.48, 0.30-0.78, 2 studies), but not for the composite outcome of any stroke, myocardial infarction, or death (RR 0.89, 0.75-1.05, 2 studies). When other antiplatelet agents (ticlodipine, cilostazol, and dipyridamole) were compared with aspirin, there was no consistent reduction in stroke recurrence (RR 0.91, 0.75-1.10, 3 studies). Dual antiplatelet therapy did not confer clear benefit over monotherapy (any stroke RR 0.83, 0.68-1.00, 3 studies; ischemic stroke RR 0.80, 0.62-1.02, 3 studies; composite outcome RR 0.90, 0.80-1.02, 3 studies).CONCLUSIONS: Our results suggest that any of the single antiplatelet agents compared with placebo in the included trials is adequate for secondary stroke prevention after lacunar stroke. Dual antiplatelet therapy should not be used for long-term stroke prevention in this stroke subtype.

KW - antiplatelet agent

KW - aspirin

KW - lacunar stroke

KW - mortality

KW - stroke

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DO - 10.1161/STROKEAHA.114.008422

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JO - Stroke

JF - Stroke

SN - 0039-2499

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