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Dual anti-platelet therapy for secondary prevention in intracranial atherosclerotic disease: a network meta-analysis

Giuseppe Reale1, Aurelia Zauli2, Giuseppe La Torre3

  • 1Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Therapeutic Advances in Neurological Disorders
|August 12, 2022
PubMed

Insights

Dual anti-platelet therapy (DAPT) is more effective than single anti-platelet therapy (SAPT) for preventing recurrent strokes in patients with intracranial arterial stenosis (ICAS). This finding supports DAPT as a key secondary prevention strategy for ICAS patients.

Area of Science:

  • Neurology
  • Cardiology
  • Clinical Trials

Background:

  • Intracranial arterial stenosis (ICAS) significantly contributes to stroke and transient ischemic attacks (TIAs), carrying a high risk of recurrence.
  • Current secondary prevention strategies for ICAS, including antithrombotic therapy and endovascular treatment (ET), lack direct comparative data, particularly between single anti-platelet therapy (SAPT) and dual anti-platelet therapy (DAPT).

Purpose of the Study:

  • To determine if DAPT is superior to SAPT in preventing recurrent stroke or TIA in patients with symptomatic ICAS.
  • To conduct a network meta-analysis (NMA) comparing various secondary prevention strategies for ICAS.

Main Methods:

  • A systematic review and Bayesian network meta-analysis (NMA) were performed following PRISMA guidelines.
  • Included studies investigated secondary prevention (SAPT, DAPT, oral anticoagulant therapy, or ET) for symptomatic ICAS, analyzing data from January 1989 to May 2021.
  • The primary efficacy outcome was the recurrence of ischemic stroke/TIA; safety outcomes were also assessed.

Main Results:

  • The NMA included 5 trials, with adequate sequence generation and blinded outcome assessment in all.
  • Dual anti-platelet therapy (DAPT) demonstrated superiority over single anti-platelet therapy (SAPT) in reducing stroke/TIA recurrence (OR, 0.59; CI, 0.39-0.9).
  • DAPT also showed improved safety compared to oral anticoagulant therapy (OAC) and DAPT plus ET, without increasing hemorrhage risk.

Conclusions:

  • Dual anti-platelet therapy (DAPT) is more effective than single anti-platelet therapy (SAPT) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (ICAS).
  • DAPT offers a favorable safety profile, not increasing the risk of hemorrhage compared to other treatments.
Abstract

Keywords:
DAPTICASanti-platelet therapyarterial stenosiscerebrovascular diseasedual anti-platelet therapyintracranial arterial stenosisintracranial atherosclerosis diseaseintracranial stenosismeta-analysisstroke

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