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Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis

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Abstract

The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are insufficiently established. Therefore, we aimed to perform a meta-analysis to compare DAPT with IV alteplase in patients with acute minor stroke. MEDLINE, Embase, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. Functional and safety outcomes in 90 days were analyzed. Statistical analysis was performed using Rstudio 4.3.1. Subanalyses were performed restricted to non-disabling minor strokes and NIHSS score ≤ 3. PROSPERO (CRD42023440986). We included five studies with a total of 6,340 patients, of whom 4,050 (63.9%) received DAPT. The follow-up period for all included studies was 90 days. There was no significant difference for individual outcomes of mRS 0–1 (OR 1.26; 95% CI 0.85–1.89; p = 0.25), mRS 0–2 (OR 0.99; 95% CI 0.69–1.43; p = 0.97), or all-cause mortality (OR 0.80; 95% CI 0.20–3.13; p = 0.75) between groups. Symptomatic intracranial hemorrhage (sICH) was significantly lower (OR 0.11; 95% CI 0.003–0.36; p < 0.001) in patients treated with DAPT compared with IV alteplase. In terms of mRS 0–1 and mRS 0–2, we found no significant difference in both subgroup analyses. We found no statistically significant difference between DAPT and IV alteplase regarding functional outcome (mRS scores of 0–1 and 0–2) or all-cause mortality at 90 days in patients with minor ischemic stroke. Additionally, DAPT was associated with a significantly lower rate of sICH.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Universidade Do Extremo Sul Catarinense, Departamento de Medicina, Criciuma, Santa Catarina, Brazil

    Patricia Viana & Jorge Eduardo Persson

  2. Conjunto Hospitalar Do Mandaqui, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil

    Jessica Hoffmann Relvas

  3. Faculdade de Medicina Souza Marques, Departamento de Medicina, Rio de Janeiro, Rio de Janeiro, Brazil

    Thamiris Dias Delfino Cabral

  4. Universidade Federal Do Mato Grosso, Departamento de Medicina, Sinop, Mato Grosso, Brazil

    Artur Menegaz de Almeida

  5. Universidade Federal de Pelotas, Departamento de Medicina, Pelotas, Rio Grande Do Sul, Brazil

    Marina Persson

  6. Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina, São Paulo, São Paulo, Brazil

    Marcos Vinícius Oliveira Marques

  7. Hospital Universitário Professor Edgar Santos, Departamento de Neurologia, Universidade Federal da Bahia, Salvador, Bahia, Brazil

    Jamary Oliveira-Filho

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  1. Patricia Viana
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Contributions

Conceptualization, methodology and project administration: P.V.; investigation: P.V., J.H.R., T.D.D.C., J.E.P., and M.P. formal analysis: P.V., J.E.P, and A.M.A.; writing – original draft: P.V. and M.V.O.M..; writing-review & editing: all authors. Supervision: J.O.F.

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Correspondence to Patricia Viana.

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Highlights

• Efficacy and safety of Dual Antiplatelet Therapy (DAPT) versus intravenous (IV) alteplase in minor ischemic stroke patients admitted within 4.5 hours of symptom onset.

• No statistically significant differences were found between DAPT and IV alteplase in terms of modified Rankin Scale (mRS) scores of 0–1 and 0–2 and all-cause mortality rates at 90 days.

• DAPT was associated with significantly lower rates of symptomatic intracranial hemorrhage when compared to IV alteplase.

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Viana, P., Relvas, J.H., Cabral, T.D.D. et al. Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis. J Thromb Thrombolysis (2024). https://doi.org/10.1007/s11239-024-02994-z

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  • DOI: https://doi.org/10.1007/s11239-024-02994-z

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