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Meta-Analysis
. 2021 Dec 1;21(1):574.
doi: 10.1186/s12872-021-02384-w.

Stroke of antiplatelet and anticoagulant therapy in patients with coronary artery disease: a meta-analysis of randomized controlled trials

Qiao Yu Shao  1 , Zhi Jian Wang  2   3 , Xiao Teng Ma  1 , Xu Ze Lin  1 , Liu Pan  1 , Yu Jie Zhou  1
Affiliations
Meta-Analysis

Stroke of antiplatelet and anticoagulant therapy in patients with coronary artery disease: a meta-analysis of randomized controlled trials

Qiao Yu Shao et al. BMC Cardiovasc Disord. .

Abstract

Background: We performed a meta-analysis sought to investigate the risk of stroke with antiplatelet and anticoagulant therapies among patients with coronary artery disease (CAD).

Methods: We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials from January 1995 to March 2020. Studies were retrieved if they reported data of stroke for patients with CAD and were randomized to receive intensive versus conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC). Analyses were pooled by random-effects modeling. A total of 42 studies with 301,547subjects were enrolled in this analysis.

Results: Intensive antithrombotic therapy significantly reduced risk of all stroke (RR 0.86, 95% CI 0.80-0.94) and ischemic stroke (RR 0.80, 95% CI 0.71-0.91), but increased risk of hemorrhagic stroke (RR 1.36, 95% CI 1.00-1.86) and intracranial hemorrhage (RR 1.46, 95% CI 1.17-1.81). Subgroup analyses indicated that OAC yields more benefit to all stroke than antiplatelet therapy (OAC: RR 0.73, 95% CI 0.58-0.92; Antiplatelet: RR 0.90, 95% CI 0.83-0.97; Between-group heterogeneity P value = 0.030). The benefit of antiplatelet therapy on all stroke and ischemic stroke were mainly driven by the studies comparing longer versus shorter duration of dual antiplatelet therapy (All stroke: RR 0.86, 95% CI 0.78-0.95; ischemic stroke: RR 0.84, 95% CI 0.75-0.94).

Conclusions: Among CAD patients who have already received antiplatelet therapy, either strengthening antiplatelet or anticoagulant treatments significantly reduced all stroke, mainly due to the reduction of ischemic stroke, although it increased the risk of hemorrhagic stroke and intracranial hemorrhage. OAC yields more benefit to all stroke than antiplatelet therapy.

Keywords: Anticoagulant; Antiplatelet; Coronary artery disease; Meta-analysis; Stroke.

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Conflict of interest statement

We declare that we have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study selection
Fig. 2
Fig. 2
Estimates of risk for all stroke between intensive antithrombotic therapy and conservative antithrombotic therapy
Fig. 3
Fig. 3
Estimates of risk for ischemic stroke and hemorrhagic stroke between intensive antithrombotic therapy and conservative antithrombotic therapy
See this image and copyright information in PMC

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References

    1. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals frcom the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–2236. - PubMed
    1. Viles-Gonzalez JF, Fuster V, Badimon JJ. Atherothrombosis: a widespread disease with unpredictable and life-threatening consequences. Eur Heart J. 2004;25:1197–1207. - PubMed
    1. Amarenco P, Steg PG. Stroke is a coronary heart disease risk equivalent: implications for future clinical trials in secondary stroke prevention. Eur Heart J. 2008;29:1605–1607. - PubMed
    1. Greving JP, Buskens E, Koffijberg H, Algra A. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation. 2008;117:2875–2883. - PubMed
    1. Augustovski FA, Cantor SB, Thach CT, Spann SJ. Aspirin for primary prevention of cardiovascular events. J Gen Intern Med. 1998;13:824–835. - PMC - PubMed

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