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Meta-Analysis
. 2014 Mar 26;2014(3):CD000029.
doi: 10.1002/14651858.CD000029.pub3.

Oral antiplatelet therapy for acute ischaemic stroke

Peter A G Sandercock  1 , Carl Counsell, Mei-Chiun Tseng, Emanuela Cecconi
Affiliations
Meta-Analysis

Oral antiplatelet therapy for acute ischaemic stroke

Peter A G Sandercock et al. Cochrane Database Syst Rev. .

Update in

  • Oral antiplatelet therapy for acute ischaemic stroke.
    Minhas JS, Chithiramohan T, Wang X, Barnes SC, Clough RH, Kadicheeni M, Beishon LC, Robinson T. Minhas JS, et al. Cochrane Database Syst Rev. 2022 Jan 14;1(1):CD000029. doi: 10.1002/14651858.CD000029.pub4. Cochrane Database Syst Rev. 2022. PMID: 35028933 Free PMC article.

Abstract

Background: In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long-term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage.

Objectives: To assess the efficacy and safety of immediate oral antiplatelet therapy (that is started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke.

Search methods: We searched the Cochrane Stroke Group Trials Register (last searched 16 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2013), MEDLINE (June 1998 to May 2013), and EMBASE (June 1998 to May 2013). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies.

Selection criteria: Randomised trials comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke.

Data collection and analysis: Two review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross-checked the data.

Main results: We included eight trials involving 41,483 participants. No new trials have been added since the last update.Two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 98% of the data. The risk of bias was low. The maximum follow-up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow-up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99). For every 1000 people treated with aspirin, 13 people would avoid death or dependency (number needed to treat 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this small hazard was significantly outnumbered by the benefit, the reduction in recurrent ischaemic stroke and pulmonary embolus.

Authors' conclusions: Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in people who cannot swallow) and started within 48 hours of onset of presumed ischaemic stroke, reduced the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications; long-term outcomes were improved.

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Conflict of interest statement

Peter Sandercock was the principal investigator of the International Stroke Trial (IST 1997).

Carl Counsell was on the Steering Committee of IST. He has received from a variety of manufacturers of antiplatelet and anticoagulant drugs (Sanofi, Bristol Meyer Squibb, Sanofi‐Synthelabo, Organon, Boehringer Ingelheim, Janssen) lecture fees and travel expenses for lectures delivered at conferences; consultancy fees; has in the past received research grants from Glaxo‐Wellcome and Boehringer Ingelheim; and the drug supply for the start‐up phase of the IST‐3 trial was donated to his department by Boehringer Ingelheim. However, he does not have any contractual consultancy arrangements with any company, or any current research grants from any company, nor does he hold stock (or hold any other financial interests) in any pharmaceutical company.

Gordon Gubitz: randomised participants in the IST.

Mei‐Chiun Tseng: none known.

Figures

1
1
Flow diagram.
2
2
Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.1 Death or dependence at end of follow‐up.
3
3
Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.2 Deaths from all causes during treatment period.
1.1
1.1. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 1 Death or dependence at end of follow‐up.
1.2
1.2. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 2 Deaths from all causes during treatment period.
1.3
1.3. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 3 Deaths from all causes during follow‐up.
1.4
1.4. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 4 Deep venous thrombosis during treatment period.
1.5
1.5. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 5 Pulmonary embolism during treatment period.
1.6
1.6. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 6 Recurrent ischaemic/unknown stroke during treatment period.
1.7
1.7. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 7 Symptomatic intracranial haemorrhage during treatment period.
1.8
1.8. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 8 Any recurrent stroke/intracranial haemorrhage during treatment period.
1.9
1.9. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 9 Major extracranial haemorrhage during treatment period.
1.10
1.10. Analysis
Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 10 Complete recovery from stroke (post hoc).
See this image and copyright information in PMC

Update of

References

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