Evidence map›Paper›PMID 30511260›Full record

SynthesisJournal of thrombosis and thrombolysis2019

Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials.

Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Bakr Swaid, Sahar Ahmed, Adam Chahine, Mustafa Hassan, Ghassan Bachuwa, Mohammed Al Qasmi and 1 more

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Journal of thrombosis and thrombolysis, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06196047 (Ticagrelor Versus Cilostazol in Ischemic Stroke), which is not on this map. Cited by 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 3 pooled it
3.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06196047 phase3recruitingnot on this mapstarted 2023, after this paper: background citation

Ticagrelor Versus Cilostazol in Ischemic Stroke

TypeinterventionalSponsorKafrelsheikh UniversityRan2023 to 2024Enrolled900ConditionsIschemic StrokeArmsTicagrelor 90 MG, Cilostazol 100 MG
3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Analysis ofBMJ open · 2021
    Article
  12. Article
  13. Review
  14. Observational
  15. Novel Antiplatelet Therapies for Atherothrombotic Diseases.Arteriosclerosis, thrombosis, and vascular biology · 2019
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Babikir KheiriDepartment of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Mohammed OsmanDivision of Cardiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.
Ahmed AbdallaDivision of Hematology & Oncology, Ascension St. John Hospital, Grosse Pointe Woods, MI, 48236, USA.
Tarek HaykalDepartment of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Bakr SwaidDepartment of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Sahar AhmedResearch Assistance, Flint, MI, 48503, USA.
Adam ChahineDepartment of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Mustafa HassanDivision of Cardiology, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Ghassan BachuwaDepartment of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Mohammed Al QasmiDivision of Neurology, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
Deepak L BhattBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. dlbhattmd@post.harvard.edu.
Hurley Medical Center · USMichigan State University · USHarvard University · USSt. John Hospital & Medical Center · USWest Virginia University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Recurrent stroke is common immediately following a transient ischemic attack (TIA) or ischemic stroke. Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may provide greater protection against subsequent stroke than monotherapy. Electronic databases were searched for randomized clinical trials (RCTs) comparing DAPT with monotherapy in ischemic stroke/TIA. Sixteen RCTs with a total of 29,032 patients were included. Compared with monotherapy, DAPT was associated with significantly lower rates of any stroke (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.72-0.89) and ischemic stroke (RR 0.75; 95% CI 0.66-0.85) during any follow-up period. Although significant increases in intracranial bleeding (RR 1.55; 95% CI 1.20-2.01) and major bleeding (RR 1.90; 95% CI 1.33-2.72) were associated with DAPT, especially with long-term follow-up, the number needed to harm was 258 and 113, respectively. Nevertheless, short-duration DAPT (≤ 1 month) started during the early acute ischemic phase was associated with less bleeding than longer DAPT and greater reduction of recurrent strokes compared with monotherapy. In contrast, long DAPT and DAPT started later after the index event (≥ 1 month) were associated with similar rates of any stroke and increased risks of bleeding compared with monotherapy. Other clinical outcomes were essentially similar between the two groups and included recurrent TIA (RR 0.88; 95% CI 0.72-1.07), myocardial infarction (RR 1.04; 95% CI 0.84-1.29), vascular death (RR 0.99; 95% CI 0.82-1.19), and any death (RR 1.12; 95% CI 0.88-1.42). Similar findings were observed in patients who presented with minor stroke/TIA. Conclusions: Among patients who presented with ischemic stroke/TIA, short-course clopidogrel plus aspirin immediately following the index event appears to be more effective than and as safe as monotherapy for secondary stroke prevention.

Indexed as

AspirinBrain IschemiaClopidogrelDrug Administration ScheduleDrug Therapy, CombinationHemorrhageHumansIschemic Attack, TransientPlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicRecurrenceRisk AssessmentRisk FactorsSecondary PreventionStrokeTime FactorsAspirinClopidogrelPlatelet Aggregation InhibitorsAcute strokeAspirinClopidogrelDAPTIschemic strokeMeta-analysisTIA

Identifiers

PMID30511260
OpenAlexW2903357985

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.