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Abstract Details

Which antiplatelet is the right choice for the secondary prevention of ischemic stroke or transient ischemic attack: A meta-analysis.
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (8:00 AM-9:00 AM)
4-001

We performed this meta-analysis to compare efficacy and safety of long-term antiplatelet therapies after ischemic stroke or transient ischemic attack

Antiplatelet is the best FDA approved medical treatment as secondary prevention . We still lack clear recommendations on the selection of antiplatelet therapies for long-term secondary prevention of stroke.
Thirty-one randomized trials were included in our meta-analysis which compared nine antiplatelets. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary endpoint was ischemic stroke recurrence. Secondary outcome included composite events (myocardial infarction, death, any other vascular event) and hemorrhagic stroke.

We identified 31 randomized controlled trials including a total of 121,173 patients. Cilostazol was found to be most efficacious in preventing ischemic stroke followed by clopidogrel. Cilostazol significantly reduced stroke recurrence in comparison with aspirin (OR0.67, 95% CI 0.54-0.84) and dipyridamole (OR 0.59, 95% CI 0.46-0.91). The proportion of subjects who had composite events were significantly lower among those randomized to cilostazol treatment compared with aspirin (OR 0.86; 95% CI 0.82-0.94). Cilostazol also had better trends which were statistically not significant in terms of lowering hemorrhagic stroke when compared with other antiplatelets.

Cilostazol has a better risk-benefit profile for long term secondary prevention after a stroke or transient ischemic attack.
Authors/Disclosures

PRESENTER 		No disclosure on file
Muhammad F. Ishfaq, MD Dr. Ishfaq has nothing to disclose.
Reza Bavarsad Shahripour, MD (University of California, San Diego (UCSD)) Dr. Bavarsad Shahripour has nothing to disclose.
Aman Deep, MD Dr. Deep has nothing to disclose.
Ana Hossein Zadeh Maleki, MD (Loma Linda University) Dr. Hossein Zadeh Maleki has nothing to disclose.
Fnu Abhi Pandhi, MD (UTHSC Dept of Neurology) No disclosure on file