Dual Antiplatelet Therapy versus Intravenous Tissue Plasminogen Activator With Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis of Safety and Efficacy

Authors

Abdallah Abbas, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
Abdullah Ashraf Hamad, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Mostafa Hossam El Din Moawad, Faculty of Pharmacy Clinical Department, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Dalia Kamal Ewis, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
Rana Ahmed Youssef, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Heba Hamouda, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Malak A. Hassan, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Mohammad Aladawi, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Mohamed Elfil, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Mostafa Meshref, Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Fawaz Al-Mufti, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA. Electronic address: Fawaz.al-mufti@wmchealth.org.Follow

Author Type(s)

Faculty

DOI

10.1016/j.jstrokecerebrovasdis.2024.107704

Journal Title

Journal of Stroke and Cerebrovascular Diseases

First Page

107704

Document Type

Article

Publication Date

7-1-2024

Department

Neurology

Abstract

OBJECTIVES: To compare the safety and efficacy of Dual Antiplatelet Therapy (DAPT) and Intravenous (IV) Tissue Plasminogen Activator (t-PA) in minor Acute Ischemic Stroke (AIS). MATERIALS AND METHODS: Following Cochrane and PRISMA guidelines, we analyzed observational studies and clinical trials comparing DAPT and IV t-PA in patients with minor AIS. Databases included PubMed, Scopus, and Web of Science. Data extraction included study characteristics, patient demographics, and analyzed outcomes. RevMan 5.3 and OpenMetaAnalyst 2021 were used to analyze the data and assess heterogeneity, respectively. The risk of bias was determined using RoB 2.0 and the Newcastle-Ottawa scale. RESULTS: This meta-analysis included five studies with 3,978 DAPT-treated patients and 2,224 IV t-PA-treated patients. We found no significant differences in achieving modified Rankin scale (mRS) scores of 0-1 (OR 1.11, 95 % CI: 0.79, 1.55, p = 0.56) and 0-2 (OR 0.90, 95 % CI: 0.61, 1.31, p = 0.57), as well as combined mRS scores (OR 1.05, 95 % CI: 0.82, 1.34, p = 0.72). Similarly, there were no significant disparities between the two treatment groups in NIHSS score change from baseline (MD 0.32, 95 % CI: -0.35, 0.98, p = 0.35) and in mortality rates (OR 0.87, 95 % CI: 0.26, 2.93, p = 0.83). Notably, in comparison to the IV t-PA group, the DAPT group exhibited a significantly lower incidence of bleeding (OR 0.31, 95 % CI: 0.14, 0.69, p = 0.004) and symptomatic intracranial hemorrhage (sICH) (OR 0.10, 95 % CI: 0.04, 0.26, p < 0.00001). CONCLUSIONS: Our meta-analysis found no significant differences in efficacy between DAPT and IV t-PA. However, DAPT demonstrated a significantly lower risk of sICH and bleeding compared with IV t-PA.

Recommended Citation

Abbas, A., Hamad, A. A., El Din Moawad, M. H., Ewis, D. K., Youssef, R. A., Hamouda, H., Hassan, M. A., Aladawi, M., Elfil, M., Meshref, M., & Al-Mufti, F. (2024). Dual Antiplatelet Therapy versus Intravenous Tissue Plasminogen Activator With Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis of Safety and Efficacy. Journal of Stroke and Cerebrovascular Diseases, 33 (7), 107704. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107704