Author:
Shao Qiao Yu,Wang Zhi Jian,Ma Xiao Teng,Lin Xu Ze,Pan Liu,Zhou Yu Jie
Abstract
Abstract
Background
We performed a meta-analysis sought to investigate the risk of stroke with antiplatelet and anticoagulant therapies among patients with coronary artery disease (CAD).
Methods
We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials from January 1995 to March 2020. Studies were retrieved if they reported data of stroke for patients with CAD and were randomized to receive intensive versus conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC). Analyses were pooled by random-effects modeling. A total of 42 studies with 301,547subjects were enrolled in this analysis.
Results
Intensive antithrombotic therapy significantly reduced risk of all stroke (RR 0.86, 95% CI 0.80–0.94) and ischemic stroke (RR 0.80, 95% CI 0.71–0.91), but increased risk of hemorrhagic stroke (RR 1.36, 95% CI 1.00–1.86) and intracranial hemorrhage (RR 1.46, 95% CI 1.17–1.81). Subgroup analyses indicated that OAC yields more benefit to all stroke than antiplatelet therapy (OAC: RR 0.73, 95% CI 0.58–0.92; Antiplatelet: RR 0.90, 95% CI 0.83–0.97; Between-group heterogeneity P value = 0.030). The benefit of antiplatelet therapy on all stroke and ischemic stroke were mainly driven by the studies comparing longer versus shorter duration of dual antiplatelet therapy (All stroke: RR 0.86, 95% CI 0.78–0.95; ischemic stroke: RR 0.84, 95% CI 0.75–0.94).
Conclusions
Among CAD patients who have already received antiplatelet therapy, either strengthening antiplatelet or anticoagulant treatments significantly reduced all stroke, mainly due to the reduction of ischemic stroke, although it increased the risk of hemorrhagic stroke and intracranial hemorrhage. OAC yields more benefit to all stroke than antiplatelet therapy.
Funder
China Postdoctoral Science Foundation
Beijing Postdoctoral Research Foundation
Project funded by National Key Research and Development Program of China
Beijing Municipal Administration of Hospitals’ Mission plan
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine