Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2025-01-01T06:45:02.610Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 September 2023

Ronda Lun Open the ORCID record for Ronda Lun [Opens in a new window] ,
Gabriele Zitikyte ,
Danielle Carole Roy ,
Shan Dhaliwal  and
Dar Dowlatshahi
Ronda Lun*
Affiliation:
University of Ottawa – School of Epidemiology and Public Health, Ottawa, ON, Canada Ottawa Hospital Research Institute – Clinical Epidemiology Program, Ottawa, ON, Canada Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
Gabriele Zitikyte
Affiliation:
University of Ottawa – School of Epidemiology and Public Health, Ottawa, ON, Canada Ottawa Hospital Research Institute – Clinical Epidemiology Program, Ottawa, ON, Canada
Danielle Carole Roy
Affiliation:
University of Ottawa – School of Epidemiology and Public Health, Ottawa, ON, Canada
Shan Dhaliwal
Affiliation:
University of Ottawa – School of Epidemiology and Public Health, Ottawa, ON, Canada
Dar Dowlatshahi
Affiliation:
University of Ottawa – School of Epidemiology and Public Health, Ottawa, ON, Canada Ottawa Hospital Research Institute – Clinical Epidemiology Program, Ottawa, ON, Canada Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
*
Corresponding author: R. Lun; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Résumé :

RÉSUMÉ :

Le traitement des petits accidents vasculaires cérébraux et des accidents ischémiques transitoires par la bithérapie : mise à jour d’une méta-analyse en réseau.

L’équipe de recherche s’est déjà penchée, dans le cadre d’une méta-analyse en réseau (MAR), sur cinq essais de traitement par le ticagrélor et l’aspirine ou par le clopidogrel et l’aspirine chez des patients ayant subi un petit accident vasculaire cérébral ou un accident ischémique transitoire. Elle a ensuite procédé à une mise à jour de la recherche et a relevé 311 nouvelles citations et retenu une étude, soit CHANCE2, à laquelle ont participé des patients porteurs d’allèles de perte de fonction du CYP2C19 qui ont reçu au hasard soit l’association de ticagrélor et d’aspirine, soit l’association de clopidogrel et d’aspirine. Toutefois, la mise en commun de CHANCE2 avec les études originales n’a pu être achevée pour non-respect des hypothèses émises dans la MAR, en raison d’importantes incohérences. Les résultats portent donc à croire que les patients porteurs d’allèles de perte de fonction du CYP2C19 forment un sous-groupe particulier de malades qui réagit d’une manière fondamentalement différente de la population générale au traitement des AVC par les antiagrégants plaquettaires. Aussi se peut-il que les résultats de l’essai CHANCE2 ne soient pas généralisables sans test génotypique.

Keywords

stroketransient ischemic attack (TIA)antiplatelet therapyticagrelorclopidogrelaspirin
Type
Brief Communication
Information
Canadian Journal of Neurological Sciences , Volume 51 , Issue 4 , July 2024 , pp. 577 - 580
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lun, R, Dhaliwal, S, Zitikyte, G, Roy, DC, Hutton, B, Dowlatshahi, D. Comparison of ticagrelor vs clopidogrel in addition to aspirin in patients with minor ischemic stroke and transient ischemic attack: a network meta-analysis. JAMA Neurol. 2022;79:141–8. DOI: 10.1001/jamaneurol.2021.4514.CrossRefGoogle ScholarPubMed
Wang, Y, Meng, X, Wang, A, et al. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021;385:2520–30. DOI: 10.1056/NEJMoa2111749.CrossRefGoogle ScholarPubMed
Hutton, B, Salanti, G, Caldwell, DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84. DOI: 10.7326/M14-2385.CrossRefGoogle ScholarPubMed
Zitikyte, G, Roy, DC, Dhaliwal, S, et al. Ticagrelor vs clopidogrel in addition to aspirin in minor ischemic stroke/ transient ischemic attack—Protocol for a systematic review and network meta-analysis. PLOS ONE. 2021;16:e0250553. DOI: 10.1371/journal.pone.0250553.CrossRefGoogle ScholarPubMed
Page, MJ, McKenzie, JE, Bossuyt, PM,, et al. The PRISMA 2020 Statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. DOI: 10.1136/bmj.n71.CrossRefGoogle ScholarPubMed
Sterne, JAC, Savović, J, Page, MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. DOI: 10.1136/bmj.l4898.CrossRefGoogle ScholarPubMed
Béliveau, A, Boyne, DJ, Slater, J, Brenner, D, Arora, P. BUGSnet: an R package to facilitate the conduct and reporting of bayesian network meta-analyses. BMC Med Res Methodol. 2019;19:196. DOI: 10.1186/s12874-019-0829-2.CrossRefGoogle Scholar
Dias, S, Welton, NJ, Sutton, AJ, et al. NICE DSU Technical Support Document 4: Inconsistency in networks of evidence based on randomised controlled trials [Internet]. London: National Institute for Health and Care Excellence (NICE); 2014, PMID: 27466656.Google Scholar
Wang, Y, Wang, Y, Zhao, X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11–9. DOI: 10.1056/NEJMoa1215340.CrossRefGoogle ScholarPubMed
Wang, Y, Chen, W, Lin, Y, et al. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. BMJ. 2019;365:l2211. DOI: 10.1136/bmj.l2211.CrossRefGoogle ScholarPubMed
Wangqin, R, Laskowitz, DT, Wang, Y, et al. International comparison of patient characteristics and quality of care for ischemic stroke: analysis of the China national stroke registry and the American heart association get with the guidelines--stroke program. J Am Heart Assoc. 2018;7:e010623. DOI: 10.1161/JAHA.118.010623.CrossRefGoogle ScholarPubMed
Bang, OY. Intracranial atherosclerosis: current understanding and perspectives. J Stroke. 2014;16:27–35. DOI: 10.5853/jos.2014.16.1.27.CrossRefGoogle Scholar
Jin, H, Zhu, S, Wei, JW, et al. Factors associated with prehospital delays in the presentation of acute stroke in Urban China. Stroke. 2012;43:362–70. DOI: 10.1161/STROKEAHA.111.623512.CrossRefGoogle ScholarPubMed
Xie, Q, Xiang, Q, Liu, Z, et al. Effect of CYP2C19 genetic polymorphism on the pharmacodynamics and clinical outcomes for patients treated with ticagrelor: a systematic review with qualitative and quantitative meta-analysis. BMC Cardiovasc Disord. 2022;22:111. DOI: 10.1186/s12872-022-02547-3.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lun et al. supplementary material

Lun et al. supplementary material

Download Lun et al. supplementary material(File)
File 15.8 KB