Abstract Details

Title Dual Antiplatelet Therapy Versus Tissue Plasminogen Activating Factor with Acute Minor Ischemic Stroke: A Systematic Review and Meta-analysis of Safety and Efficacy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S41 - Sociodemographics of Stroke and Policy in Stroke Care (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

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).

Objective To assess the safety and efficacy of DAPT versus t-PA in acute minor ischemic stroke.

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.

Authors/Disclosures
Mostafa M. Meshref, MD (Al-Azhar University, Cairo) PRESENTER	Dr. Meshref has nothing to disclose.
Abdallah Abbas	Dr. Abbas has nothing to disclose.
Abdullah Hamad, MD (Menoufia University)	Dr. Hamad has nothing to disclose.
Mostafa El Din Moawad	No disclosure on file
Dalia Kamal Ewis	No disclosure on file
Rana Ahmed Youssef	No disclosure on file
Heba Hamouda	No disclosure on file
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .