Optimal duration of dual antiplatelet therapy for secondary stroke prevention: A systematic review and meta-analysis.
J Clin NeurosciMay 31, 2026 (epub)
André Richard da Silva Oliveira Filho, Natália Vasconcellos de Oliveira Souza, Daniel Macedo de Oliveira et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) for secondary stroke prevention in 27,167 patients. DAPT significantly reduced major ischemic events (MIE) in the first week (4.098% vs 5.759%; RR = 0.71) but not thereafter, while major bleeding risk increased during the first two weeks.
Key findings
- DAPT reduced MIE risk in the first week (4.098% vs 5.759%; RR = 0.71).
- By week 5, aspirin monotherapy had a lower MIE risk (0.285% vs 0.074%; RR = 3.64).
- DAPT increased major bleeding risk in weeks 1 (0.221% vs 0.066%; RR = 2.48) and 2 (0.139% vs 0.036%; RR = 3.27).
- The benefit-to-risk ratio was most favorable in week 1 (12.87), decreasing sharply in weeks 2-3 (1.68).
Why it matters
Understanding the temporal dynamics of DAPT efficacy and safety can guide clinicians in optimizing treatment duration for secondary stroke prevention, balancing ischemic benefits against bleeding risks.