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P.072 Ticagrelor vs Clopidogrel in Addition to Aspirin in Minor Ischemic Stroke/ TIA – a Systematic Review & Network Meta-Analysis (NMA)

Published online by Cambridge University Press:  05 January 2022

R Lun
Affiliation:
(Ottawa)*
S Dhaliwal
Affiliation:
(Ottawa)
G Zitikyte
Affiliation:
(Ottawa)
D Roy
Affiliation:
(Ottawa)
B Hutton
Affiliation:
(Ottawa)
R Shorr
Affiliation:
(Ottawa)
D Dowlatshahi
Affiliation:
(Ottawa)
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Abstract

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Background: Dual antiplatelet therapy (DAPT) is recommended after minor ischemic stroke/ transient ischemic attack (TIA), but Clopidogrel/ Aspirin has never been compared directly to Ticagrelor/ Aspirin. Our objective is to compare these regimens in terms of efficacy and safety. Methods: Medline, Embase, and Cochrane were searched for randomized controlled trials (RCTs) that enrolled adults with minor stroke/ TIA and administered antiplatelets within 72 hours. The primary efficacy outcome is recurrent stroke or death at 90 days. We performed a Bayesian-approach NMA. Between group comparisons were presented as odds-ratios (OR) with 95% credible intervals (95%CI). Sucraplots were based on calculated probabilities of rankings for individual outcomes. Results: 9/4014 studies were included: 5 RCTs and 4 subgroup analyses. 22,098 patients were analyzed. At 90 days, both DAPT regimens were superior to Aspirin in the prevention of recurrent stroke/ death. There was no significant difference between Clopidogrel/ ASA compared to Ticagrelor/ ASA (OR 0.90 [95%CI 0.74 – 1.09]), although Clopidogrel/ Aspirin was ranked #1 using Sucraplots. There was no significant difference between the interventions for mortality, bleeding, or adverse events. Conclusions: DAPT was superior to ASA in the prevention of recurrent strokes/ death, but there was no difference between Clopidogrel/ ASA and Ticagrelor/ ASA.

Type
Poster Presentations
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation