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
Meta-Analysis
. 2019 Dec 1:2019:1607181.
doi: 10.1155/2019/1607181. eCollection 2019.

Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis

Maurizio Paciaroni  1 , Birsen Ince  2 , Bo Hu  3 , Jiann-Shing Jeng  4 , Kursad Kutluk  5 , Liping Liu  6 , Min Lou  7 , Vladimir Parfenov  8 , Ka Sing Lawrence Wong  9 , Babak Zamani  10 , Dara Paek  11 , Jung Min Han  11 , Michael Del Aguila  11 , Shalini Girotra  12
Affiliations
Meta-Analysis

Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis

Maurizio Paciaroni et al. Cardiovasc Ther. .

Abstract

Aim: Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to compare clopidogrel versus aspirin monotherapy in this population.

Methods: PubMed, Embase, and CENTRAL databases were searched from inception to May 2018 to identify clinical trials and observational studies comparing clopidogrel versus aspirin for secondary prevention in patients with recent ischemic stroke within 12 months. Pooled effect estimates were calculated using a random effects model and were reported as risk ratios with 95% confidence intervals.

Results: Five studies meeting eligibility criteria were included in the analysis. A total of 29,357 adult patients who had recent ischemic stroke received either clopidogrel (n = 14, 293) or aspirin (n = 15, 064) for secondary prevention. Pairwise meta-analysis showed a statistically significant risk reduction in the occurrence of major adverse cardiovascular and cerebrovascular events (risk ratio 0.72 [95% CI, 0.53-0.97]), any ischemic or hemorrhagic stroke (0.76 [0.58, 0.99), and recurrent ischemic stroke (0.72 [0.55, 0.94]) in patients who received clopidogrel versus aspirin. The risk of bleeding was also lower for clopidogrel versus aspirin (0.57 [0.45, 0.74]). There was no difference in the rate of all-cause mortality between the two groups.

Conclusions: The analysis showed lower risks of major adverse cardiovascular or cerebrovascular events, recurrent stroke, and bleeding events for clopidogrel monotherapy compared to aspirin. These findings support clinical benefit for single antiplatelet therapy with clopidogrel over aspirin for secondary prevention in patients with recent ischemic stroke.

PubMed Disclaimer

Conflict of interest statement

Maurizio Paciaroni received honoraria as a member of the speaker bureau of Aspen, Sanofi-Aventis, Boehringer Ingelheim, Bayer, Bristol Meyer Squibb, Daiiki Sankyo and Pfizer. Birsen Ince has received honoraria from Pfizer and Sanofi-Aventis within the past 36 months, outside the submitted work. Kursad Kutluk has received honoraria from Boehringer Ingelheim, Pfizer and Sanofi-Aventis within the past 36 months, outside the submitted work. Dara Paek, Jung Min Han, and Michael del Aguila report employment by Doctor Evidence at the time in which this research was conducted, who was contracted by Sanofi to perform the analysis. Shalini Girotra reports employment by Sanofi. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing study identification and selection.
Figure 2
Figure 2
Forest plots showing pooled risk ratio of (a) MACCE, (b) any ischemic or hemorrhagic stroke, (c) recurrent ischemic stroke, and (d) all-cause mortality.
Figure 3
Figure 3
Forest plot showing pooled risk ratio for bleeding events.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Feigin V. L., Roth G. A., Naghavi M., et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology. 2016;15:913–924. doi: 10.1016/S1474-4422(16)30073-4. - DOI - PubMed
    1. Benjamin E. J., Blaha M. J., Chiuve S. E., et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485. - DOI - PMC - PubMed
    1. Feng W., Hendry R. M., Adams R. J. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010;74(7):588–593. doi: 10.1212/WNL.0b013e3181cff776. - DOI - PubMed
    1. Engel-Nitz N. M., Sander S. D., Harley C., Rey G. G., Shah H. Costs and outcomes of noncardioembolic ischemic stroke in a managed care population. Vascular Health and Risk Management. 2010;6:905–913. doi: 10.2147/VHRM.S10851. - DOI - PMC - PubMed
    1. Burn J., Dennis M., Bamford J., Sandercock P., Wade D., Warlow C. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke. 1994;25:333–337. doi: 10.1161/01.str.25.2.333. - DOI - PubMed

MeSH terms