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TOPLINE:

Adding oral anticoagulants (OACs) to standard antiplatelet therapy did not reduce recurrence in patients with acute ischaemic stroke (AIS) and no indication for oral anticoagulation; however, this addition resulted in more than double the risk for major haemorrhage, a meta-analysis found.

METHODOLOGY:

• This systematic review and meta-analysis included 6893 patients with AIS but no indication for oral anticoagulation (mean age, 66.2 years; 50.4% women) from four randomised controlled trials identified by searching three databases until January 14, 2025.
• A total of 3067 participants were randomly assigned to receive OAC plus antiplatelet therapy, whereas 3826 participants received placebo plus antiplatelet therapy.
• Primary outcomes were the recurrence of AIS and the occurrence of major haemorrhage; secondary outcomes were any stroke and covert brain infarct detected using MRI.
• The median follow-up duration was between 90 days and 20 months across the included studies.

TAKEAWAY:

• A total of 430 recurrences of AIS were observed during the follow-up period.
• No significant difference in the risk for the recurrence of AIS was observed between combination therapy and antiplatelet therapy alone (odds ratio [OR], 0.89; 95% CI, 0.68-1.17).
• The risk for major haemorrhage was significantly higher in the combination therapy group than in the antiplatelet therapy alone group (OR, 2.21; 95% CI, 1.25-3.90).
• Combination therapy showed no significant advantage over antiplatelet therapy alone in terms of net clinical benefit (OR, 1.12; 95% CI, 0.88-1.43) and the risk for any stroke (OR, 0.88; 95% CI, 0.65-1.18) and covert brain infarct (OR, 1.06; 95% CI, 0.86-1.31).

IN PRACTICE:

"The currently available evidence does not support the strategy of combining oral anticoagulants with antiplatelets, as it does not reduce the risk of recurrent ischaemic stroke and increases the risk of major bleeding," the authors wrote. They recommended against the use of the combination strategy "in patients with acute ischaemic stroke and no indication for oral anticoagulation, unless the results of ongoing trials like the LIBREXIA-Stroke and OCEANIC-Stroke yield different conclusions."

SOURCE:

This study was led by Anastasia Adamou, First Propedeutic Department of Internal Medicine & Stroke Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. It was published online on April 12 in the International Journal of Stroke.

LIMITATIONS:

This meta-analysis was not an individual patient data analysis, which may have allowed for more detailed analyses. Additionally, four trials with different designs were analysed, introducing variability in study populations, follow-up duration, the timing of treatment initiation, and patient features.

DISCLOSURES:

This study did not receive any specific funding. Several authors reported receiving research grants and scholarships from various sources outside the submitted work, all paid to their institutions. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.