Abstract WMP6: Dual Antiplatelet Therapy versus Alteplase in Patients With Minor Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Caroline Dagostin, Jéssica Sales de Oliveira, Ofonime Chantal Udoma Udofa, Otávio Martins, Denilsa Navalha, Mateus Neves Faria Fernandes, Julyana Medeiros Dantas, Julia Pereira Muniz Pontes, Fernando Cotrim Gomes, Gabriela Borges Nager, Anna Laura Lima Larcipretti, Matheus de Andrade Bannach- Advanced and Specialized Nursing
- Cardiology and Cardiovascular Medicine
- Neurology (clinical)
Background: Minor stroke, defined as a National Institutes of Health Stroke Scale (NIHSS), score of less than or equal to 5, accountedfor half of Acute Ischemic Stroke (AIS) patients in 2019 . Given the low impairment on function, there is a debate about which therapy is better for these patients: intravenous alteplase or double antiplatelet therapy (DAPT).Research question: For patients with minor AIS who can be treated within 24 hours after symptom onset, is alteplase associated with better outcomes and a good safety profile?
Methods: We systematically searched PubMed, Web of Science, and EMBASE. Outcomes of interest included: Modified Rankin Scale (mRS) 0-1, symptomatic intracranial hemorrhage (sICH) and stroke recurrence. Heterogeneity was examined with I2 statistics, and a random-effects model was used for all of the outcomes due to expected high heterogeneity.
Results: We included 1 randomized controlled trial and 3 observational cohorts, comprising 2,224 patients. DAPT was administered to 1,395 (62.7%) patients. DAPT was associated with a significantly lower incidence of sICH (OR 0.21; 95% CI 0.05-0.83; P=0.03; Fig 1A). There was no significant difference between DAPT and alteplase in good clinical outcome (mRS 0-1) at 90 days (OR 1.19; 95% CI 0.67-2.11; P=0.55; Fig 1B) or stroke recurrence (OR 0.87; 95% CI 0.51-1.48; P=0.61; Fig 1C).
Conclusion: In this systematic review and meta-analysis comparing alteplase and DAPT in patients with minor non-disabling acute stroke, DAPT was associated with lower risk of sICH and there was nodifference in excellent clinical outcome or stroke recurrence at 90 days.