Odat Ramez M, Alshwayyat Sakhr, Bahdar Zainab I, Abdelraheem Mohammad, Khalefa Basma B, Jarah Omar, Obeidat Mohammad H, Bani Khalaf Mohammad E, Bani Khalaf Aon J, Hussein Ayham Mohammad, Yasin Jehad A, Hanifa Hamdah, Jain Hritvik
Faculty of Medicine, Jordan University of Science and Technology, Jordan.
King Hussein Cancer Center, Jordan.
J Int Med Res. 2025 May;53(5):3000605251337035. doi: 10.1177/03000605251337035. Epub 2025 May 13.
IntroductionData regarding the role of dual antiplatelet therapy in patients with ischemic stroke or transient ischemic attack are limited. This study aimed to systematically review and analyze the efficacy and safety of dual antiplatelet therapy compared with aspirin alone in patients with acute ischemic stroke or transient ischemic attack.MethodsWe searched PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception to August 2024 and identified randomized controlled trials comparing dual antiplatelet therapy with aspirin alone in patients with stroke. Pooled risk ratios with 95% confidence interval were calculated. Trial sequential analysis was conducted for the main outcomes to weigh the risks of type I and type II errors.ResultsFive studies involving 27,563 patients were included. Dual antiplatelet therapy was associated with a significantly reduced risk of recurrent ischemic stroke (risk ratio: 0.74, 95% confidence interval: 0.68-0.81) and major adverse cardiovascular events (risk ratio: 0.77, 95% confidence interval: 0.71-0.84). However, it was associated with a significantly higher risk of recurrent hemorrhagic stroke (risk ratio: 2.13, 95% confidence interval: 1.09-4.17) and bleeding (risk ratio: 2.21, 95% confidence interval: 1.48-3.32). Trial sequential analysis revealed that sufficient evidence for recurrent ischemic stroke, major adverse cardiovascular events, and bleeding was achieved.ConclusionDual antiplatelet therapy demonstrated a lower incidence of recurrent ischemic stroke and major adverse cardiovascular events compared with aspirin alone. However, further studies are warranted to provide sufficient evidence regarding recurrent hemorrhagic stroke and all-cause mortality.
引言
关于双重抗血小板治疗在缺血性中风或短暂性脑缺血发作患者中的作用的数据有限。本研究旨在系统评价和分析双重抗血小板治疗与单独使用阿司匹林相比，在急性缺血性中风或短暂性脑缺血发作患者中的疗效和安全性。
方法
我们检索了从数据库建立至2024年8月的PubMed、Embase、Scopus、Cochrane和Web of Science数据库，纳入比较双重抗血小板治疗与单独使用阿司匹林治疗中风患者的随机对照试验。计算合并风险比及95%置信区间。对主要结局进行序贯试验分析，以权衡I型和II型错误的风险。
结果
纳入5项研究，共27563例患者。双重抗血小板治疗与复发性缺血性中风风险显著降低相关（风险比：0.74，95%置信区间：0.68 - 0.81），与主要不良心血管事件风险显著降低相关（风险比：0.77，95%置信区间：0.71 - 0.84）。然而，它与复发性出血性中风风险显著升高相关（风险比：2.13，95%置信区间：1.09 - 4.17），与出血风险显著升高相关（风险比：2.21，95%置信区间：1.48 - 3.32）。序贯试验分析显示，复发性缺血性中风、主要不良心血管事件和出血的证据充足。
结论
与单独使用阿司匹林相比，双重抗血小板治疗复发性缺血性中风和主要不良心血管事件的发生率较低。然而，需要进一步研究以提供关于复发性出血性中风和全因死亡率的充分证据。
