Evidence map›Paper›PMID 38580815›Full record

SynthesisJournal of neurology2024

Ticagrelor versus clopidogrel in dual antiplatelet therapy after minor stroke or transient ischemic attack: an updated network meta-analysis.

Gabriel Marinheiro, Beatriz Araújo, Gabriel de Almeida Monteiro, Marianna Leite, Antonio Mutarelli, Artur Menegaz de Almeida, Joaquim Francisco Cavalcante-Neto, André Rivera, Agostinho C Pinheiro, João Paulo Mota Telles

Abstract readSystematic ReviewComparative StudyNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 3 pooled it
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Interaction of CYP2C19 with the effect of clopidogrel in secondary prevention of major ischemic events: Systematic review and meta-analysis.International journal of stroke : official journal of the International Stroke Society · 2026
    Pooled it
  2. Pooled it
  3. Pooled it
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

10 authors.

Gabriel Marinheiro *School of Medicine, Federal University of Ceará, Sobral, Brazil. gabrielmarinheirosb@gmail.com.ORCID http://orcid.org/0009-0001-8040-6515
Beatriz Araújo *Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.ORCID http://orcid.org/0000-0002-1392-2544
Gabriel de Almeida Monteiro *School of Medicine, Federal University of Ceará, Sobral, Brazil.ORCID http://orcid.org/0000-0003-2319-9238
Marianna LeiteSchool of Medicine, Santa Marcelina College, São Paulo, Brazil.ORCID http://orcid.org/0000-0001-5816-1438
Antonio MutarelliSchool of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.ORCID http://orcid.org/0000-0002-5595-9433
Artur Menegaz de AlmeidaFederal University of Mato Grosso, Sinop, Brazil.ORCID http://orcid.org/0009-0004-3869-7373
Joaquim Francisco Cavalcante-NetoDepartment of Neurosurgery, Federal University of Ceará, Sobral, Brazil.ORCID http://orcid.org/0000-0001-6495-5875
André RiveraDepartment of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.ORCID http://orcid.org/0009-0006-1310-1590
Agostinho C PinheiroDepartment of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA.ORCID http://orcid.org/0000-0002-2496-9479
João Paulo Mota TellesDepartment of Neurology, University of São Paulo, São Paulo, Brazil.ORCID http://orcid.org/0000-0001-9322-0405

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDual antiplatelet therapy (DAPT) with clopidogrel plus aspirin is a well-established practice after a minor stroke or transient ischemic attack (TIA). However, ticagrelor plus aspirin may be an alternative.

aimsWe systematically searched PubMed, Embase, and Cochrane Central from inception to January 2024. We included randomized controlled trials (RCTs) enrolling adults with acute minor stroke or TIA within 72 hours of the onset of the symptoms.

resultsA total of 8 RCTs were included in our meta-analysis. Ticagrelor plus aspirin (RR, 0.70; 95% CrI 0.52, 0.91) and clopidogrel plus aspirin (RR, 0.79; 95% CrI 0.64, 0.98) were superior to aspirin in preventing stroke recurrence in overall analysis. Excluding studies with dual antiplatelet up to 90 days, ticagrelor plus aspirin was the only strategy that maintained superiority compared with aspirin regarding stroke recurrence (RR, 0.70; 95% CrI 0.51, 0.95) and ischemic stroke (RR, 0.68; 95% CrI 0.47, 0.94). There was no significant difference between treatment groups regarding hemorrhagic stroke, functional disability, and mortality.

conclusionsDAPTs were superior to aspirin in preventing recurrence or ischemic stroke. Although no significant difference was observed between DAPTs, ticagrelor plus aspirin may be related to worse major bleeding results, including intracranial bleeding. Ticagrelor plus aspirin is a considerable option for patients after a minor stroke or TIA.

Indexed as

ClopidogrelDual Anti-Platelet TherapyIschemic Attack, TransientPlatelet Aggregation InhibitorsStrokeTicagrelorAspirinDrug Therapy, CombinationHumansIschemic StrokeRandomized Controlled Trials as TopicAspirinClopidogrelPlatelet Aggregation InhibitorsTicagrelorClopidogrelDual antiplateletMeta-analysisStrokeTicagrelorTransient ischemic attack

Identifiers

PMID38580815

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.