Clopidogrel and Aspirin versus Aspirin Alone for Stroke Prevention: A Meta-Analysis

被引:12
|
作者
Tan, Shuai [1 ]
Xiao, Xiaojuan [2 ]
Ma, Hanyu [3 ]
Zhang, Zhaohui [4 ]
Chen, Jiangbo [5 ]
Ding, Lei [6 ]
Yu, Shenping [2 ]
Xu, Rulin [7 ]
Yang, Shiliang [1 ]
Huang, Xinyi [1 ]
Hong, Hua [1 ]
机构
[1] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Neurol, Guangzhou 510080, Guangdong, Peoples R China
[2] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Radiol, Guangzhou 510080, Guangdong, Peoples R China
[3] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Pathol, Guangzhou 510080, Guangdong, Peoples R China
[4] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Pancreatobiliary Surg, Guangzhou 510080, Guangdong, Peoples R China
[5] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Intervent Radiol, Guangzhou 510080, Guangdong, Peoples R China
[6] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Thorac Surg, Guangzhou 510080, Guangdong, Peoples R China
[7] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Cardiol, Guangzhou 510080, Guangdong, Peoples R China
来源
PLOS ONE | 2015年 / 10卷 / 08期
关键词
TRANSIENT ISCHEMIC ATTACK; CEREBRAL INFARCTION; RECURRENCE; RISK; SURVIVAL;
D O I
10.1371/journal.pone.0135372
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background and Purpose Antiplatelet therapy is widely used for the primary or secondary prevention of stroke. Drugs like clopidogrel have emerged as alternatives for traditional antiplatelet therapy, and dual therapy with clopidogrel and aspirin is of particular interest. We conducted this meta-analysis to systematically review studies about dual therapy comparing monotherapy with aspirin alone. Methods Randomized controlled trials were searched in PubMed (1966-May, 2015), EMBASE (1947-May, 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (1948-May, 2015), WHO International Clinical Trial (ICTRP) (2004-May, 2015), China Biology Medicine disc (CBM disc) (1978-May, 2015) and were included into the final analysis according to the definite inclusion criteria mentioned in the study selection section. Risk ratio (RR) was pooled with 95% confidence interval (CI) for dichotomous data. The heterogeneity was considered significant if the chi(2) test was significant (P value < 0.10) or the I-2 > 50.00%. Subgroup analyses were carried out on the long and short time periods, the race and region. Results We included 5 studies involving 24,084 patients. A pooled analysis showed that dual therapy with clopidogrel and aspirin had a lower stroke incidence than monotherapy in both the short term and long term (RR = 0.69, 95% CI: 0.59-0.82, P <0.05; RR = 0.84, 95% CI: 0.72-0.98, P = 0.03, respectively). With regard to safety, dual therapy had a higher risk of bleeding than monotherapy for both periods (RR = 1.51, 95% CI: 1.03-2.23, P = 0.04; RR = 1.54, 95% CI: 1.32-1.79, P<0.05, respectively). Conclusions Dual therapy with clopidogrel and aspirin could be a preferable choice to prevent stroke in patients who have had a previous stroke or transient ischemic attack, as well as those who are at high risk for stroke. And the effect of dual therapy seems to be more obvious for short-term. However, it is associated with a higher risk of bleeding.
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页数:14
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