Favorable benefit-risk balance for oral antiplatelet agents in acute ischaemic stroke

Cochrane Pre-hospital and Emergency Care

Favorable benefit-risk balance for oral antiplatelet agents in acute ischaemic stroke

Source

Minhas, J. S., Chithiramohan, T., Wang, X., Barnes, S. C., Clough, R. H., Kadicheeni, M., Beishon, L. C., & Robinson, T. (2022). Oral antiplatelet therapy for acute ischaemic stroke.

Cochrane Database Syst Rev, 1, CD000029

BACKGROUND

Strokes constitute a major public health problem worldwide (15 million cases/year) and are mostly ischaemic. Oral antiplatelet agents aim to reduce the risk of cerebral ischemia by inhibiting platelet adhesion and aggregation. However, antiplatelet agents could also increase the risk of fatal or disabling intracranial haemorrhage.

OBJECTIVES

Does the immediate or early administration (started within the first 15 days) of oral antiplatelet therapy, compared to no treatment or placebo, in people with acute presumed ischaemic stroke, effective and safe?

RESULTS

Early administration of antiplatelet agents reduces significantly the risk of death or dependence (moderate-certainty evidence), pulmonary embolism and recurrence of ischaemic/unknown stroke during the treatment period (very low-certainty evidence). Antiplatelet agents did not significantly increase the occurrence of symptomatic intracranial haemorrhage (very low-certainty evidence). However, there was a significant increase in major extracranial haemorrhage during treatment period (very low-certainty evidence). The risk of deep vein thrombosis could not be evaluated due to the limited amount of data.

CAVEAT

Ninety-six percent of the data come from two trials of medium-dose aspirin (160-300 mg daily) started within 48 hours of onset of presumed ischaemic stroke. Although aspirin is inexpensive and easy to administer, it is important that additional trials evaluate the effect of other antiplatelet agents as well as their interactions during treatments such as intravenous thrombolysis and mechanical thrombectomy.

Authors

Y. Auffret

y.aunmail@gmail.com

Urgence SMUR, F-29200 Brest, France

 D. Meyran

daniel.meyran@me.com

BMPM, F-13003 Marseille, France