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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: rondalun920@gmail.com
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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 , First View , pp. 1 - 4
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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References

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