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In people who have had a lacunar stroke, single antiplatelet therapy prevents stroke compared with placebo

Kwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke. 2015;46:1014-23.

Review question

In people who have had a lacunar stroke, does antiplatelet therapy prevent stroke from happening again?

Background

A stroke happens when blood flow to the brain is interrupted or blocked and brain cells are damaged or die. A stroke caused by blood clots is called an ischemic stroke. When blood flow to one of the small arteries deep in the brain becomes blocked, the stroke is called a lacunar stroke. About 25% of ischemic strokes are lacunar strokes. People who have had a lacunar stroke are generally treated with 1 or 2 antiplatelet drugs, such as aspirin, clopidogrel, ticlopidine, cilostazol, or dipyridamole to prevent a stroke from happening again.

How the review was done

The researchers did a systematic review, searching for studies published up to December 2013. They found 17 randomized controlled trials of 42,234 people who had a lacunar stroke (average age 64 years, 65% men).

Trials compared single (1 drug) or dual antiplatelet therapy (2 drugs) with placebo, aspirin, or another antiplatelet.

What the researchers found

Single antiplatelet therapy prevented any stroke and ischemic stroke more than placebo.

Single antiplatelet therapy was not different from aspirin.

Dual antiplatelet therapy prevented any stroke, but not ischemic stroke, compared with aspirin.

Single or dual antiplatelet therapies were not different from single antiplatelet therapy with clopidogrel.

Conclusion

In people who have had a lacunar stroke, single antiplatelet therapy prevents stroke from happening again compared with placebo. Dual antiplatelet therapies do not have a clear advantage over single therapies.

Single or dual antiplatelet therapy vs placebo, aspirin, or clopidogrel in people with lacunar stroke

*Aspirin or other single antiplatelet therapy.

†Single antiplatelet therapy with ticlopidine, cilostazol, or dipyridamole.

‡Although the rates for the 2 groups look different, the difference was not statistically significant. This means that the difference could simply be due to chance rather than due to the different treatments

§Dual antiplatelet therapy with clopidogrel, cilostazol, or dipyridamole plus aspirin.

|||Single or dual antiplatelet therapies including ticlopidine, dipyridamole plus aspirin, or clopidogrel plus aspirin.