Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Mar;97(13):e0123.
doi: 10.1097/MD.0000000000010123.

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

Jian-Jun Zhang  1 , Xin Liu
Affiliations
Review

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

Jian-Jun Zhang et al. Medicine (Baltimore). 2018 Mar.

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure statement: All the authors declare that no actual or potential conflicts of interests exist.

Figures

Figure 1
Figure 1
The Cochrane Collaboration's tool for the assessment of the risk of bias of the selected studies.
Figure 2
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
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
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).
See this image and copyright information in PMC

References

    1. Gao HH, Gao LB, Wen JM. Correlations of MCP-1-2518A>G polymorphism and serum levels with cerebral infarction risk: a meta-analysis. DNA Cell Biol 2014;33:522–30. - PMC - PubMed
    1. O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–23. - PubMed
    1. Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke 2011;42:2351–5. - PubMed
    1. Sen S, Rabinstein AA, Elkind MS, et al. Recent developments regarding human immunodeficiency virus infection and stroke. Cerebrovasc Dis 2012;33:209–18. - PubMed
    1. Shimizu M, Yoshimura S, Takizawa S, et al. Effect of single nucleotide polymorphisms of the prostacyclin receptor gene on platelet activation in Japanese healthy subjects and patients with cerebral infarction. J Clin Neurosci 2013;20:851–6. - PubMed

MeSH terms