Aspirin plus dipyridamole has the highest surface under the cumulative ranking curves (SUCRA) values in terms of mortality, intracranial hemorrhage, and adverse event rate among 7 drug therapies in the treatment of cerebral infarction

Abstract

Background: The standardization for the clinical use of drug therapy for cerebral infarction (CI) has not yet determined in some aspects. In this paper, we discussed the efficacies of different drug therapies (aspirin, aspirin plus dipyridamole, aspirin plus clopidogrel, aspirin plus warfarin, cilostazol, warfarin, and ticlopidine) for CI.

Methods: We searched databases of PubMed and Cochrane Library from the inception to April, 2017, randomized controlled trials (RCTs) met the inclusion and exclusion criteria were enrolled in this study. The network meta-analysis integrated evidences of direct and indirect comparisons to assess odd ratios (OR) and surface under the cumulative ranking curves (SUCRA) value.

Results: Thirteen eligible RCTs including 7 drug therapies were included into this network meta-analysis. The network meta-analysis results showed that CI patients who received aspirin plus dipyridamole presented lower mortality when compared with those received aspirin plus clopidogrel (OR = 0.46, 95% CI = 0.18-0.99), indicating aspirin plus dipyridamole therapy had better efficacy for CI. As for intracranial hemorrhage (ICH), stroke recurrence, and adverse event (AE) rate, there were no significant differences of efficacy among 7 drug therapies. Besides, SUCRA values demonstrated that in the 7 drug therapies, aspirin plus dipyridamole therapy was more effective than others (mortality: 80.67%; ICH: 76.6%; AE rate: 90.2%).

Conclusions: Our findings revealed that aspirin plus dipyridamole therapy might be the optimum one for patients with CI, which could help to improve the survival of CI patients.

Figure 1

The Cochrane Collaboration's tool for the assessment of the risk of bias of the selected studies.

Figure 2

Network evidence graphs of mortality, ICH, stroke recurrence, and AE rate among 7 drug therapies in the treatment of CI. (Note: AE = adverse events, CI = confidence interval, ICH = intracranial hemorrhage).

Figure 3

Relative relationship forest plots of mortality among (A) aspirin, (B) aspirin plus dipyridamole, (C) aspirin plus clopidogrel, (D) cilostazol, (E) warfarin, and (F) ticlopidine therapies in the treatment of CI. CI = confidence interval.

Figure 4

The SUCRA diagrams in terms of mortality, ICH, stroke recurrence, and AE rate among 7 drug therapies in the treatment of CI. (Note: AE = adverse events, CI = confidence interval, ICH = intracranial hemorrhage, SUCRA = surface under the cumulative ranking curves).