摘要
Objective Recent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention.We updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke(IS)or transient ischaemic attack(TIA).Methods We searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May 2018.Risk ratio(RR)with 95%CI were calculated using random effects models.Clinical endpoints included stroke recurrence,composite vascular events and major bleeding.results 18 randomised controlled trials including 15515 patients were pooled in the meta-analysis.When compared with monotherapy among patients with acute IS or TIA,dual antiplatelet therapy reduced the risk of stroke recurrence(RR 0.69;95%CI 0.61 to 0.78;p<0.001)and composite vascular events(RR 0.72;95%CI 0.64 to 0.80;p<0.001).Dual therapy was associated with a significant increase in the risk of major bleeding(RR 1.77;95%CI 1.09 to 2.87;p=0.02)when all trial data were combined.However,when all previous trials before the completion of the POINT trial were analysed,dual antiplatelet versus monotherapy was not associated with a significant increase in the risk of major bleeding(RR 1.46;95%CI 0.77 to 2.75;p=0.25).Conclusions Among patients with acute noncardioembolic IS or TIA within 3 days of ictus,dual antiplatelet therapy was associated with a reduction in stroke recurrence,and composite vascular events,when compared with monotherapy.However,a significant increase in the risk of major bleeding was observed.
