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Got It, Hide thisKwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke. 2015;46:1014-23.
In people who have had a lacunar stroke, does antiplatelet therapy prevent stroke from happening again?
A stroke happens when blood flow to the brain is interrupted or blocked and brain cells are damaged or die. A stroke caused by blood clots is called an ischemic stroke. When blood flow to one of the small arteries deep in the brain becomes blocked, the stroke is called a lacunar stroke. About 25% of ischemic strokes are lacunar strokes. People who have had a lacunar stroke are generally treated with 1 or 2 antiplatelet drugs, such as aspirin, clopidogrel, ticlopidine, cilostazol, or dipyridamole to prevent a stroke from happening again.
The researchers did a systematic review, searching for studies published up to December 2013. They found 17 randomized controlled trials of 42,234 people who had a lacunar stroke (average age 64 years, 65% men).
Trials compared single (1 drug) or dual antiplatelet therapy (2 drugs) with placebo, aspirin, or another antiplatelet.
Single antiplatelet therapy prevented any stroke and ischemic stroke more than placebo.
Single antiplatelet therapy was not different from aspirin.
Dual antiplatelet therapy prevented any stroke, but not ischemic stroke, compared with aspirin.
Single or dual antiplatelet therapies were not different from single antiplatelet therapy with clopidogrel.
In people who have had a lacunar stroke, single antiplatelet therapy prevents stroke from happening again compared with placebo. Dual antiplatelet therapies do not have a clear advantage over single therapies.
Outcomes at 4 weeks to 3.5 years | Number of trials (number of people) | Rate of events with treatment | Rate of events with control | Absolute effect of treatment |
|
| Single antiplatelet* | Placebo |
|
Any stroke | 2 trials (2215 people) | 11% | 15% | About 4 fewer people out of 100 had any stroke |
Ischemic stroke | 2 trials (858 people) | 5.4% | 11% | About 56 fewer people out of 1000 had ischemic stroke |
|
| Single antiplatelet† | Aspirin |
|
Any stroke | 3 trials (4224 people) | 8.8% | 9.6% | No difference‡ |
|
| Dual antiplatelet§ | Aspirin |
|
Any stroke | 3 trials (4491 people) | 7.8% | 9.4% | About 16 fewer people out of 1000 had any stroke |
Ischemic stroke | 3 trials (3287 people) | 6.3% | 7.8% | No difference‡ |
|
| Single or dual antiplatelet|| | Clopidogrel |
|
Any stroke | 1 trials (10 578 people) | 7.9% | 8.3% | No difference‡ |
Ischemic stroke | 1 trials (3148 people) | 10.0% | 10.3% | No difference‡ |