[Meta-analysis on the efficacy and adverse events of aspirin plus clopidogrel versus aspirin-monotherapy in patients with ischemic stroke or transient ischemic attack]

Abstract

Objective: To present the systematic assessment on the efficacy and bleeding adverse events of dual-antiplatelet therapy with aspirin and clopidogrel versus aspirin-mono-antiplatelet therapy in patients with ischemic stroke or transient ischemic attack.

Methods: Retrieve randomized controlled trials conformed to the inclusion and exclusion criteria in Cochrane Library, Medline, Embase, and Web of Science electronic database, between January 1, 1998 and April 1, 2015. Cochrane Collaboration was used to assess the methodological quality of the included research papers. Stratification analysis was performed on factors as: race, subtypes of the disease, duration of follow-up and with or without clopidogrel loading dose, of the patients.

Results: A total of 7 studies were eligible for analysis, including 14 022 study objects. Data from Meta-analysis showed that dual-antiplatelet therapy, when compared to the mono-therapy group, could reduce the risk of recurrent stroke (RR=0.71, 95%CI: 0.61-0.84, P<0.001) , at the same time, increase the risk of bleeding events (RR=1.60, 95%CI: 1.46-1.76, P<0.001). Data derived from the Hierarchical analysis showed that the risk of stroke recurrence in Chinese population (RR=0.55, 95%CI: 0.34-0.89) was lower than recorded in other populations (RR=0.78, 95%CI: 0.66-0.93) , with the risks of bleeding events as RR=1.41 (95%CI: 1.01-1.96) and RR=1.62 (95%CI: 1.47-1.79) , respectively. Risk of recurrence among the group with clopidogrel loading dose (RR=0.69, 95%CI: 0.58-0.81) was less than those without (RR=0.74, 95%CI:0.56-0.99). The risks of occurrence on bleeding events were RR=1.59 (95%CI: 1.10-2.30) and RR=1.60 (95%CI: 1.46-1.77) , respectively.

Conclusion: The combined therapy of aspirin and clopidogrel could reduce the risk of recurrence of ischemic stroke and TIA patients, but increase the risk of bleeding, when compared to the group that using aspirin alone for the therapy. In Chinese population, the combined therapy seemed more effective than using aspirin alone in reducing the recurrence of stroke, but without increasing the risk of bleeding.