Universidade Do Extremo Sul Catarinense, Departamento de Medicina, Criciuma, Santa Catarina, Brazil.
Conjunto Hospitalar Do Mandaqui, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil.
J Thromb Thrombolysis. 2024 Aug;57(6):929-935. doi: 10.1007/s11239-024-02994-z. Epub 2024 May 9.
The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are insufficiently established. Therefore, we aimed to perform a meta-analysis to compare DAPT with IV alteplase in patients with acute minor stroke. MEDLINE, Embase, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. Functional and safety outcomes in 90 days were analyzed. Statistical analysis was performed using Rstudio 4.3.1. Subanalyses were performed restricted to non-disabling minor strokes and NIHSS score ≤ 3. PROSPERO (CRD42023440986). We included five studies with a total of 6,340 patients, of whom 4,050 (63.9%) received DAPT. The follow-up period for all included studies was 90 days. There was no significant difference for individual outcomes of mRS 0-1 (OR 1.26; 95% CI 0.85-1.89; p = 0.25), mRS 0-2 (OR 0.99; 95% CI 0.69-1.43; p = 0.97), or all-cause mortality (OR 0.80; 95% CI 0.20-3.13; p = 0.75) between groups. Symptomatic intracranial hemorrhage (sICH) was significantly lower (OR 0.11; 95% CI 0.003-0.36; p < 0.001) in patients treated with DAPT compared with IV alteplase. In terms of mRS 0-1 and mRS 0-2, we found no significant difference in both subgroup analyses. We found no statistically significant difference between DAPT and IV alteplase regarding functional outcome (mRS scores of 0-1 and 0-2) or all-cause mortality at 90 days in patients with minor ischemic stroke. Additionally, DAPT was associated with a significantly lower rate of sICH.
双重抗血小板治疗(DAPT)相对于急性小缺血性卒中患者的静脉内(IV)阿替普酶的疗效和安全性尚未充分确定。因此,我们旨在进行一项荟萃分析,以比较急性小卒中患者的 DAPT 与 IV 阿替普酶。我们检索了 MEDLINE、Embase 和 Cochrane 数据库,以比较小卒中患者的 DAPT 与 IV 阿替普酶。在 90 天内分析功能和安全性结局。使用 Rstudio 4.3.1 进行统计分析。亚分析限于非致残性小卒中且 NIHSS 评分≤3。PROSPERO(CRD42023440986)。我们纳入了五项共 6340 例患者的研究,其中 4050 例(63.9%)接受了 DAPT。所有纳入研究的随访期为 90 天。两组间 mRS 0-1(OR 1.26;95%CI 0.85-1.89;p=0.25)、mRS 0-2(OR 0.99;95%CI 0.69-1.43;p=0.97)或全因死亡率(OR 0.80;95%CI 0.20-3.13;p=0.75)的个别结局均无显著差异。与 IV 阿替普酶相比,DAPT 治疗的患者的症状性颅内出血(sICH)发生率显著降低(OR 0.11;95%CI 0.003-0.36;p<0.001)。在 mRS 0-1 和 mRS 0-2 亚组分析中,我们未发现两组间存在显著差异。我们发现,在小缺血性卒中患者中,90 天时,DAPT 与 IV 阿替普酶在功能结局(mRS 评分 0-1 和 0-2)或全因死亡率方面无统计学显著差异。此外,DAPT 与 sICH 发生率显著降低相关。