The efficacy and safety of different antiplatelet regimes for stroke prevention in patients at high risk were investigated in a systematic review and meta-analysis.

Background and Purpose—The efficacy and safety of different antiplatelet regimes for stroke prevention in patients at high risk were investigated in a systematic review and meta-analysis. Methods—We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science. Twenty-two studies comprising 173371 patients were included. 

Results—In the overall population, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in comparison to aspirin monotherapy reduced the relative risk of total stroke by 20% (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.73-0.88; P<0.0001; I2 =28%) and of ischemic stroke or transient ischemic attack by 23% (RR, 0.77; 95% CI, 0.69-0.85; P<0.0001; I2 =18%) without increasing the risk of intracranial haemorrhage. In the secondary prevention cohort, DAPT with aspirin and clopidogrel also reduced the relative risk of total stroke by 24% as compared with aspirin alone (RR, 0.76; 95% CI, 0.68-0.86; P<0.0001; I2 =0%). DAPT with prasugrel or ticagrelor and aspirin versus DAPT with clopidogrel and aspirin was not associated with a stroke risk reduction. 

Conclusions—DAPT with clopidogrel and aspirin compared with aspirin effectively reduces the risk of total and ischemic stroke in the overall cohort consisting of patients with cardiovascular disease without an increase in intracranial haemorrhage, as well as