Dual Antiplatelet Therapy Versus Tissue Plasminogen Activating Factor with Acute Minor Ischemic Stroke: A Systematic Review and Meta-analysis of Safety and Efficacy
Abdallah Abbas1, Abdullah Hamad2, Mostafa Hossam3, Dalia Kamal Ewis4, Rana Ahmed Youssef5, Heba Hamouda2, Mostafa Meshref6, Fawaz Al-Mufti7
1Faculty of Medicine, Al-Azhar University, Damietta, Egypt, 2Faculty of Medicine, Menoufia University, Menoufia, Egypt, 3Msc Faculty of Medicine Suez Canal University, Ismailia, Egypt, 4Faculty of Medicine, Beni Suef University, Beni Suef, Egypt, 5Faculty of Medicine, Alexandria University, Alexandria, Egypt, 6Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 7Westchester Medical Center at New York Medical College
Objective:
To assess the safety and efficacy of DAPT versus t-PA in acute minor ischemic stroke.
Background:
Acute minor ischemic stroke is a common and challenging clinical scenario that requires prompt intervention to optimize patient outcomes. Two primary treatment options have emerged in recent years: Dual Antiplatelet Therapy (DAPT) and tissue plasminogen activating factor (t-PA).
Design/Methods:
Following Cochrane and PRISMA guidelines, we analyzed observational studies and clinical trials comparing DAPT and t-PA in this patient group. Databases included PubMed, Scopus, and Web of Science. Data extraction included study characteristics, patient demographics, and analyzed outcomes. RevMan 5.3 analyzed data and OpenMetaAnalyst 2021 assessed heterogeneity, while the risk of bias was determined with RoB 2.0 and the Newcastle-Ottawa scale.
Results:
In a meta-analysis of 5 studies involving 3,978 DAPT-treated and 2,224 t-PA-treated patients, we found no significant differences between DAPT and t-PA groups for Modified Rankin Scale (mRs) scores of 0-1 OR 1.11 (95% CI: 0.79, 1.55, p = 0.56), mRs scores of 0-2 OR 0.90 (95% CI: 0.61, 1.31, p = 0.57), and combined mRs scores OR 1.05 (95% CI: 0.82, 1.34, p = 0.72). There were also no significant disparities in NIHSS change from baseline MD 0.32 (95% CI: -0.35, 0.98, p = 0.35) and mortality rates OR 0.87 (95% CI: 0.26, 2.93, p = 0.83) between the two treatment groups. However, the analysis revealed a significantly lower incidence of symptomatic intracranial hemorrhage (sICH) in the DAPT group OR 0.10 (95% CI: 0.04, 0.26, p < 0.00001) and a significantly lower incidence of any bleeding OR 0.31 (95% CI: 0.14, 0.69, p = 0.004) when compared to the t-PA group.
Conclusions:
Our meta-analysis found no significant differences in efficacy outcomes between DAPT and t-PA. However, DAPT demonstrated a significantly lower risk of sICH and bleeding compared to t-PA.