Dual Antiplatelet Therapy versus Intravenous Thrombolysis for Patients with Acute Minor Ischaemic Stroke: A Systematic Review and Meta-analysis
Rowaid Ahmad1, Hassan Waseem2, Zain abideen3, Muhammad Abdullah Ali4, Muhammad Ansari1, Sania Aimen5, Umama Alam4
1University of Texas Medical Branch Galveston Texas, 2Allama Iqbal Medical College, Lahore, Pakistan, 3King Edward Medical University, Lahore, Pakistan, 4Khyber Medical College, Peshawar, Pakistan, 5Quetta Institute of Medical Sciences, Pakistan
Objective:
This study compared the efficacy and safety of dual antiplatelet therapy (DAPT) with intravenous thrombolysis in acute minor ischemic stroke (AMIS) patients, offering crucial insights for clinical decision-making.
Background:

Approximately one-third of patients with AMIS experience long-term functional dependence. Although the effectiveness of intravenous alteplase in treating AMIS remains uncertain due to limited clinical data, dual antiplatelet therapy, using clopidogrel and aspirin, has been shown to reduce the risk of recurrent strokes without significantly increasing the risk of hemorrhage. However, the most effective overall treatment strategy for managing AMIS continues to be unclear, highlighting the need for further research in this area.

Design/Methods:
PubMed, Scopus, and Cochrane Central were searched till September 2024. Risk Ratios (RR) with 95% Confidence Intervals (CI) were pooled for dichotomous outcomes using Review Manager version 5.4.1. The safety and efficacy outcomes were excellent functional outcome (mRS score 0–1), favorable functional outcome (mRS score 0–2), recurrent ischaemic stroke, all-cause mortality, symptomatic Intracranial hemorrhage (sICH), and early neurological deterioration. 
Results:

This meta-analysis of one randomized controlled trial and five observational cohort studies (n=7,366) compared dual antiplatelet therapy (DAPT; n=4,584) and intravenous thrombolysis (IVT; n=2,782). No significant differences were found between DAPT and IVT regarding excellent functional outcome (RR 0.97, 95% CI: 0.87-1.07, p=0.52, I2= 94%), sICH (RR 0.27, 95% CI: 0.05-1.38, p=0.12, I2= 72%), favorable functional outcome (RR 1.00, 95% CI: 0.97-1.03, p=0.97, I2= 49%), recurrent ischaemic stroke (RR 0.89, 95% CI: 0.59-1.34, p=0.59, I2= 0%), and all-cause mortality (RR 0.51, 95% CI: 0.21-1.23, p=0.13, I2=0%). However, early neurological deterioration was reduced in the DAPT group (RR 0.50, 95% CI: 0.28-0.89, p=0.02, I2= 77%).

Conclusions:

In patients with AMIS, dual antiplatelet therapy and intravenous thrombolysis show comparable efficacy regarding functional outcomes, though DAPT is associated with a lower risk of early neurological deterioration.

10.1212/WNL.0000000000212069
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