European journal of neurology · 2018
Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a systematic review and meta-analysis.
СтатьяМетаанализПоддержка исследования: вне правительства СШАСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ding L, Peng B
Аннотация
BACKGROUND AND PURPOSE: There is a lack of age-specific evidence regarding the efficacy and safety of dual antiplatelet therapy (DAPT). A systematic review and meta-analysis was conducted for dual versus mono antiplatelet therapy in elderly patients with ischaemic stroke (IS) or transient ischaemic attack (TIA).
METHODS: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Risk ratios (RRs) for the outcomes of stroke recurrence, major bleeding and intracranial bleeding were calculated based on the DerSimonian and Laird random effects model. Subgroup analyses were conducted.
RESULTS: In seven multicentre, randomized controlled trials comprising 24 873 patients with IS or TIA, aged 65 years or older, a significant reduction in the risk of recurrent stroke was observed using DAPT in comparison with aspirin monotherapy [RR 0.79, 95% confidence interval (95% CI) 0.69-0.91; P = 0.001]. DAPT was not associated with a significant reduction in recurrent stroke compared with clopidogrel monotherapy (RR 1.01, 95% CI 0.93-1.10; P = 0.800). In addition, the results from two studies showed that DAPT significantly increased the risk of major bleeding and intracranial bleeding in elderly patients over younger patients (RR 2.18, 95% CI 1.02-4.69; and RR 2.13, 95% CI 1.18-3.86, respectively).
CONCLUSIONS: For stroke prevention in elderly patients with IS or TIA, DAPT is superior to aspirin monotherapy but appears to be equivalent to clopidogrel monotherapy, and is accompanied by an increased risk of bleeding. The balance between the benefits and risks of DAPT is important to consider when choosing antiplatelet strategy.
METHODS: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Risk ratios (RRs) for the outcomes of stroke recurrence, major bleeding and intracranial bleeding were calculated based on the DerSimonian and Laird random effects model. Subgroup analyses were conducted.
RESULTS: In seven multicentre, randomized controlled trials comprising 24 873 patients with IS or TIA, aged 65 years or older, a significant reduction in the risk of recurrent stroke was observed using DAPT in comparison with aspirin monotherapy [RR 0.79, 95% confidence interval (95% CI) 0.69-0.91; P = 0.001]. DAPT was not associated with a significant reduction in recurrent stroke compared with clopidogrel monotherapy (RR 1.01, 95% CI 0.93-1.10; P = 0.800). In addition, the results from two studies showed that DAPT significantly increased the risk of major bleeding and intracranial bleeding in elderly patients over younger patients (RR 2.18, 95% CI 1.02-4.69; and RR 2.13, 95% CI 1.18-3.86, respectively).
CONCLUSIONS: For stroke prevention in elderly patients with IS or TIA, DAPT is superior to aspirin monotherapy but appears to be equivalent to clopidogrel monotherapy, and is accompanied by an increased risk of bleeding. The balance between the benefits and risks of DAPT is important to consider when choosing antiplatelet strategy.