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Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and
Maurizio Paciaroni1, Birsen Ince2, Bo Hu3
1Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy.
Insights
Clopidogrel monotherapy significantly reduced major adverse cardiovascular events, recurrent strokes, and bleeding compared to aspirin monotherapy in recent ischemic stroke patients. This suggests clopidogrel offers greater clinical benefit for secondary prevention.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Limited data compares clopidogrel and aspirin monotherapy for secondary prevention in recent ischemic stroke.
- Combination therapy (clopidogrel + aspirin) has been studied, but monotherapy efficacy and safety remain less clear.
- Secondary prevention is crucial to reduce recurrent events after an initial ischemic stroke.
Purpose of the Study:
- To compare the efficacy and safety of clopidogrel monotherapy versus aspirin monotherapy.
- To evaluate outcomes in patients with recent ischemic stroke (within 12 months).
- To determine the best single antiplatelet therapy for secondary stroke prevention.
Main Methods:
- Systematic literature search of PubMed, Embase, and CENTRAL databases up to May 2018.
- Inclusion of clinical trials and observational studies comparing clopidogrel and aspirin monotherapy.
- Meta-analysis using a random effects model to calculate pooled risk ratios and 95% confidence intervals.
Main Results:
- Five studies involving 29,357 patients (14,293 on clopidogrel, 15,064 on aspirin) were analyzed.
- Clopidogrel showed a significant reduction in major adverse cardiovascular events (RR 0.72), any stroke (RR 0.76), and recurrent ischemic stroke (RR 0.72) versus aspirin.
- Clopidogrel also demonstrated a lower risk of bleeding events (RR 0.57) with no difference in all-cause mortality.
Conclusions:
- Clopidogrel monotherapy is associated with lower risks of major adverse cardiovascular events, recurrent stroke, and bleeding compared to aspirin monotherapy.
- These findings support the clinical benefit of clopidogrel over aspirin for single antiplatelet therapy in secondary stroke prevention.
- Clopidogrel may be a preferred option for patients requiring antiplatelet therapy after a recent ischemic stroke.
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.
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