School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Faculty of Science, Melbourne University, Melbourne, Australia.
Pharmazie. 2020 Oct 1;75(10):516-523. doi: 10.1691/ph.2020.0683.
The optimal duration of dual antiplatelet therapy (DAPT) as a routine treatment in stroke patients is still controversial. The efficacy and safety of DAPT may vary with different regiments, initiating treatment time and race. Our study assessed the efficacy and safety of DAPT in patients with stroke and to determine the factors influencing the efficacy and safety of DAPT. Relevant studies published up to May 2019 from PubMed, Embase, Web of Science and the Cochrane Library. Randomized controlled trials comparing DAPT with mono antiplatelet therapy (MAPT) for stroke secondary prevention were included. The primary endpoints were stroke recurrence, ischemic stroke recurrence and all-cause death. Subgroup analysis was made according to regiment, initiating treatment time and race. Eighteen studies (n=33353) were included. Comparing with MAPT, short-term DAPT reduced stroke recurrence (RR = 0.68, 95% CI = 0.60-0.77) and ischemic stroke recurrence (RR = 0.67, 95% CI = 0.59-0.77) but increased major bleeding (RR = 1.82, 95% CI = 1.11-2.98). Long-term DAPT had no superiority compared with MAPT. Aspirin plus clopidogrel comparing with aspirin and early initiating treatment time comparing with MAPT decreased stroke recurrence (RR = 0.74, 95% CI = 0.67-0.83; RR = 0.69, 95% CI = 0.61-0.78) and ischemic stroke recurrence ( RR = 0.71, 95% CI = 0.64-0.79; RR = 0.68, 95% CI = 0.59-0.77) but also increased major bleeding (RR = 1.70, 95% CI = 1.38-2.09; RR = 1.75, 95% CI = 1.07-2.85). DAPT reduced stroke and ischemic stroke recurrence in non-Asian group but only reduced ischemic stroke recurrence in Asian group. As stroke secondary prevention, short-term DAPT rather than long-term DAPT could be a better choice. Patients could benefit more from aspirin plus clopidogrel or given DAPT within 72 h after symptoms onset. Race may be a factor influencing the efficacy of DAPT.
双联抗血小板治疗（DAPT）作为中风患者的常规治疗的最佳持续时间仍存在争议。DAPT 的疗效和安全性可能因不同的方案、起始治疗时间和种族而有所不同。我们的研究评估了 DAPT 在中风患者中的疗效和安全性，并确定了影响 DAPT 疗效和安全性的因素。检索了截至 2019 年 5 月PubMed、Embase、Web of Science 和 Cochrane 图书馆中发表的相关研究。纳入了比较 DAPT 与单药抗血小板治疗（MAPT）用于中风二级预防的随机对照试验。主要终点是中风复发、缺血性中风复发和全因死亡。根据方案、起始治疗时间和种族进行亚组分析。纳入了 18 项研究（n=33353）。与 MAPT 相比，短期 DAPT 降低了中风复发（RR=0.68，95%CI=0.60-0.77）和缺血性中风复发（RR=0.67，95%CI=0.59-0.77），但增加了大出血（RR=1.82，95%CI=1.11-2.98）。与 MAPT 相比，长期 DAPT 没有优势。与阿司匹林相比，阿司匹林加氯吡格雷和与 MAPT 相比，早期起始治疗时间降低了中风复发（RR=0.74，95%CI=0.67-0.83；RR=0.69，95%CI=0.61-0.78）和缺血性中风复发（RR=0.71，95%CI=0.64-0.79；RR=0.68，95%CI=0.59-0.77），但也增加了大出血（RR=1.70，95%CI=1.38-2.09；RR=1.75，95%CI=1.07-2.85）。DAPT 降低了非亚洲人群的中风和缺血性中风复发，但仅降低了亚洲人群的缺血性中风复发。作为中风二级预防，短期 DAPT 可能优于长期 DAPT。患者可能会从阿司匹林加氯吡格雷或在症状出现后 72 小时内给予 DAPT 中获益更多。种族可能是影响 DAPT 疗效的一个因素。
