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In people who have had a lacunar stroke, single antiplatelet therapy prevents stroke compared with placebo

Kwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke. 2015;46:1014-23.

Review question

In people who have had a lacunar stroke, does antiplatelet therapy prevent stroke from happening again?

Background

A stroke happens when blood flow to the brain is interrupted or blocked and brain cells are damaged or die. A stroke caused by blood clots is called an ischemic stroke. When blood flow to one of the small arteries deep in the brain becomes blocked, the stroke is called a lacunar stroke. About 25% of ischemic strokes are lacunar strokes. People who have had a lacunar stroke are generally treated with 1 or 2 antiplatelet drugs, such as aspirin, clopidogrel, ticlopidine, cilostazol, or dipyridamole to prevent a stroke from happening again.

How the review was done

The researchers did a systematic review, searching for studies published up to December 2013. They found 17 randomized controlled trials of 42,234 people who had a lacunar stroke (average age 64 years, 65% men).

Trials compared single (1 drug) or dual antiplatelet therapy (2 drugs) with placebo, aspirin, or another antiplatelet.

What the researchers found

Single antiplatelet therapy prevented any stroke and ischemic stroke more than placebo.

Single antiplatelet therapy was not different from aspirin.

Dual antiplatelet therapy prevented any stroke, but not ischemic stroke, compared with aspirin.

Single or dual antiplatelet therapies were not different from single antiplatelet therapy with clopidogrel.

Conclusion

In people who have had a lacunar stroke, single antiplatelet therapy prevents stroke from happening again compared with placebo. Dual antiplatelet therapies do not have a clear advantage over single therapies.

Single or dual antiplatelet therapy vs placebo, aspirin, or clopidogrel in people with lacunar stroke

Outcomes at 4 weeks to 3.5 years

Number of trials (number of people)

Rate of events with treatment

Rate of events with control

Absolute effect of treatment

 

 

Single antiplatelet*

Placebo

 

Any stroke

2 trials (2215 people)

11%

15%

About 4 fewer people out of 100 had any stroke

Ischemic stroke

2 trials (858 people)

5.4%

11%

About 56 fewer people out of 1000 had ischemic stroke

 

 

Single antiplatelet†

Aspirin

 

Any stroke

3 trials (4224 people)

8.8%

9.6%

No difference‡

 

 

Dual antiplatelet§

Aspirin

 

Any stroke

3 trials (4491 people)

7.8%

9.4%

About 16 fewer people out of 1000 had any stroke

Ischemic stroke

3 trials (3287 people)

6.3%

7.8%

No difference‡

 

 

Single or dual antiplatelet||

Clopidogrel

 

Any stroke

1 trials (10 578 people)

7.9%

8.3%

No difference‡

Ischemic stroke

1 trials (3148 people)

10.0%

10.3%

No difference‡

*Aspirin or other single antiplatelet therapy.

†Single antiplatelet therapy with ticlopidine, cilostazol, or dipyridamole.

‡Although the rates for the 2 groups look different, the difference was not statistically significant. This means that the difference could simply be due to chance rather than due to the different treatments

§Dual antiplatelet therapy with clopidogrel, cilostazol, or dipyridamole plus aspirin.

|||Single or dual antiplatelet therapies including ticlopidine, dipyridamole plus aspirin, or clopidogrel plus aspirin.



Related Topics


Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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