Dual Antiplatelet Therapy in Minor Stroke/Transient Ischemic Attack - An Updated Network Meta-Analysis

Ronda Lun; Gabriele Zitikyte; Danielle Carole Roy; Shan Dhaliwal; Dar Dowlatshahi

doi:10.1017/cjn.2023.287

Dual Antiplatelet Therapy in Minor Stroke/Transient Ischemic Attack - An Updated Network Meta-Analysis

Can J Neurol Sci. 2023 Sep 11:1-4. doi: 10.1017/cjn.2023.287. Online ahead of print.

Authors

Ronda Lun^{1

2

3}, Gabriele Zitikyte^{1

2}, Danielle Carole Roy¹, Shan Dhaliwal¹, Dar Dowlatshahi^{1

2

3}

Affiliations

¹ University of Ottawa - School of Epidemiology and Public Health, Ottawa, ON, Canada.
² Ottawa Hospital Research Institute - Clinical Epidemiology Program, Ottawa, ON, Canada.
³ Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 37694524
DOI: 10.1017/cjn.2023.287

Abstract

We previously analyzed five trials on ticagrelor/aspirin versus clopidogrel/aspirin in patients with minor stroke/ TIA in a network meta-analysis. We updated our search and identified 311 new citations with one study for inclusion: CHANCE2 enrolled patients with CYP2C19 loss-of-function alleles and randomized them to ticagrelor/aspirin or clopidogrel/aspirin. Pooling of CHANCE2 with the original studies could not be completed due to violation of NMA assumptions, due to significant inconsistency. This suggests patients with CYP2C19 loss-of-function alleles represent a subpopulation that is inherently different from the general stroke population in their antiplatelet response. Results from CHANCE-2 may not be generalizable without genotype testing.

Keywords: antiplatelet therapy; aspirin; clopidogrel; stroke; ticagrelor; transient ischemic attack (TIA).