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Comparative effectiveness of dual antiplatelet therapy versus monotherapy in patients with ischemic stroke

Rahmah A Algarni1, Abdulhamid A Althagafi1, Samah Alshehri1

  • 1From the Department of Pharmacy (Algarni), King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from the Department of Pharmacy Practice (Althagafi, Alshehri, Alshibani), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia, and from the College of Pharmacy (Alshargi), Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia.

Neurosciences (Riyadh, Saudi Arabia)
|October 16, 2023
PubMed

Insights

Dual antiplatelet therapy (DAPT) showed no significant benefit over single antiplatelet therapy (AM) in preventing recurrent ischemic stroke or death. Rehospitalization rates were higher with DAPT.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Pharmacology

Background:

  • Ischemic stroke management often involves antiplatelet therapy.
  • Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is used, but its superiority over monotherapy (AM) is debated.
  • Evidence comparing DAPT and AM for ischemic stroke outcomes is limited.

Purpose of the Study:

  • To compare the effectiveness of aspirin-clopidogrel dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (aspirin or clopidogrel monotherapy, AM) in patients with ischemic stroke.
  • To evaluate differences in ischemic stroke recurrence, rehospitalization, and all-cause mortality between DAPT and AM groups.

Main Methods:

  • Retrospective, single-center cross-sectional study of ischemic stroke patients (January 2015 - October 2019).
  • Primary endpoints: ischemic stroke recurrence, rehospitalization, and all-cause mortality.
  • Statistical analysis: Kaplan-Meier and Cox proportional hazard models for time-to-event analyses.

Main Results:

  • Median time to ischemic stroke recurrence was 15.0 months for DAPT vs. 20.4 months for AM.
  • Median survival time to all-cause mortality was 8.0 months for DAPT vs. 14.1 months for AM.
  • No statistically significant differences were found in risks of recurrence (HR 1.27), re-hospitalization (HR 0.95), or mortality (HR 1.04) between DAPT and AM.

Conclusions:

  • Dual antiplatelet therapy (DAPT) was not superior to single antiplatelet therapy (AM) in reducing ischemic stroke recurrence or mortality.
  • Rehospitalization rates were higher in the DAPT group, potentially due to sequelae of stroke, angina, or myocardial infarction.
Abstract

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