Circulation：双联抗血小板治疗降低缺血性脑卒中复发风险.pdf

Stroke Early Dual Versus Mono Antiplatelet Therapy for Acute Non-Cardioembolic Ischemic Stroke or Transient Ischemic Attack An Updated Systematic Review and Meta-Analysis Ka Sing Lawrence Wong, FRCP; Yilong Wang, MD; Xinyi Leng, PhD; Chen Mao, PhD; Jinling Tang, FFPH; Philip M.W. Bath, FRCP; Hugh S. Markus, FRCP; Philip B. Gorelick, FACP; Liping Liu, MD; Wenhua Lin, PhD; Yongjun Wang, MD Background—Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA). We performed a meta-analysis of randomized, controlled trials evaluating dual versus mono antiplatelet therapy for acute noncardioembolic ischemic stroke or TIA. Methods and Results—We assessed randomized, controlled trials investigating dual versus mono antiplatelet therapy published up to November 2012 and the CHANCE trial (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), for efficacy and safety outcomes in adult patients with acute noncardioembolic ischemic stroke or TIA with treatment initiated within 3 days of ictus. In total, 14 studies of 9012 patients were included in the systematic review and meta-analysis. Dual antiplatelet therapy significantly reduced risk of stroke recurrence (risk ratio, 0.69; 95% confidence interval, 0.60–0.80; P0.001) and the composite outcome of stroke, TIA, acute coronary syndrome, and all death (risk ratio, 0.71; 95% confidence interval, 0.63–0.81; P0.001) when compared with monotherapy, and nonsignificantly increased risk of major bleeding (ris