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Antiplatelet therapy for secondary prevention of lacunar stroke: a systematic review and network meta-analysis

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Abstract

Purpose

To comprehensively compare the efficacy of different antiplatelet therapies for secondary prevention of lacunar stroke (LS).

Methods

The relevant studies were identified by searching PubMed, EMBASE, Web of Science, and Cochrane Collaboration Database up to May 2022. Cardiovascular and cerebrovascular events were chosen to evaluate the efficacy of antiplatelet therapy for secondary prevention. Loop-specific approach and node-splitting analysis were used to evaluate consistency and inconsistency, respectively. The value of the surface under the cumulative ranking (SUCRA) was calculated and ranked. Funnel-plot symmetry was used to evaluate publication bias. The meta-analysis was performed by using STATA 16.0.

Results

Thirteen studies with a total of 33,011 subjects were included in this network meta-analysis. Compared with placebo, aspirin, clopidogrel, cilostazol, ticlopidine, aspirin plus dipyridamole, and aspirin plus clopidogrel were associated with reducing cardiovascular and cerebrovascular events. The SUCRA estimated relative ranking of treatments showed that cilostazol may be the most effective (RR 0.56, 95% CI 0.42–0.74, SUCRA 95.8). No significant inconsistency or publication bias was found in the study.

Conclusions

This meta-analysis suggests that cilostazol may be a priority option for secondary prevention of patients with LS. These findings still need further study in the future.

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Availability of data and materials

The data that support the findings of the study are available from the corresponding author on reasonable request.

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Acknowledgements

We really appreciate all the participants in this study.

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Authors and Affiliations

  1. School of Public Health, Shenyang Medical College, 146 Huanghe North Street, Shenyang, 110034, China

    Xiaowen Hou, Kaiwen Cen, Ying Cui, Yuhong Zhang & Xu Feng

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  1. Xiaowen Hou
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  2. Kaiwen Cen
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  3. Ying Cui
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  4. Yuhong Zhang
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  5. Xu Feng
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Contributions

XW Hou designed the study and wrote the paper. KW Cen, Y Cui, and YH Zhang screened the literatures and extracted the data. X Feng analyzed the data.

Corresponding author

Correspondence to Xiaowen Hou.

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Our study is a systematic review and network meta-analysis, which does not involve ethical approval.

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Our study is a systematic review and network meta-analysis, which does not require informed consent.

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There are no individual’s data or image in our study.

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The authors declare no competing interests.

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Hou, X., Cen, K., Cui, Y. et al. Antiplatelet therapy for secondary prevention of lacunar stroke: a systematic review and network meta-analysis. Eur J Clin Pharmacol 79, 63–70 (2023). https://doi.org/10.1007/s00228-022-03413-z

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  • DOI: https://doi.org/10.1007/s00228-022-03413-z

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