Abstract WMP4: Dual Antiplatelet Therapy versus Alteplase in Adult Patients With Minor Ischemic Stroke: A Systematic-Review and Meta-Analysis

Introduction: The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are not well established. Therefore, we aimed to perform a meta-analysis to determine the best strategy for patients with minor stroke.

Methods: MEDLINE, EMBASE, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. The main outcome was a 90-day functional outcome assessed by modified Rankin Scale (mRS). Statistical analysis was performed using Rstudio Software. Quality assessment and risk of bias were performed according to Cochrane recommendations. Subanalyses were performed restricted to: a) non-disabling minor strokes and b) NIHSS score ≤ 3. The meta-analysis protocol was registered prospectively in PROSPERO.

Results: We included 5 studies with 6,195 patients, of whom 3,964 (64%) received DAPT, and 69.6% were male. Mean follow-up was 90 days. There was no significant difference for individual outcomes of mRS 0-1 (84% vs. 84%; OR 1.26; 95% CI 0.85-1.89; p=0.25; Figure 1A), mRS 0-2 (94% vs. 94%; OR 0.99; 95% CI 0.68-1.43; p=0.95), or all-cause mortality (0.5% vs. 0.5%; OR 0.84; 95% CI 0.21-3.28; p=0.79; Figure 1B) between groups. We found similar results, in mRS 0-1 and mRS 0-2 outcomes, in both a subgroup analysis of patients with an NIHSS score ≤ 3 and a subgroup of patients with non-disabling minor strokes.

Conclusion: To our knowledge, this is the first meta-analysis comparing DAPT with IV alteplase in patients with acute minor ischemic stroke. We found no statistically significant difference in 90-day outcomes between the groups, considering mRS scores of 0-1, 0-2, or in mortality rates. Our results indicate that both DAPT and Alteplase can be viable treatment options for these patients.