Skip to main content

REVIEW article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1484130
This article is part of the Research Topic Clinical Pharmacist Service Promotes the Improvement of Medical Quality Volume II View all 33 articles

Comparing efficacy and safety of low-dose versus standard-dose antiplatelet therapy in stroke patients: A meta-analysis

Provisionally accepted
Zhao Ren Zhao Ren Chun-xing Li Chun-xing Li *Xin Zhang Xin Zhang *Lichaoyue Sun Lichaoyue Sun Hui Zhu Hui Zhu *Dongxiao Wang Dongxiao Wang *Yumin Wang Yumin Wang *Shuo Liang Shuo Liang *Guanchun Wang Guanchun Wang *
  • Aerospace Center Hospital, Beijing, China

The final, formatted version of the article will be published soon.

    Background: Stroke is the leading cause of disability globally, with antiplatelet therapy being crucial for secondary prevention but also increasing bleeding risks. This requires careful dosage adjustments to balance thrombosis and bleeding risks. Objective: This study compared the efficacy and safety of low-dose versus standard-dose antiplatelet therapy in stroke patients. Methods: We conducted a comprehensive search across multiple databases, including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, CNKI, and the Wanfang Medical Database, up to March 2024. Only randomized controlled trials assessing low-dose antiplatelet therapy in stroke patients were considered. The Cochrane Risk of Bias Tool (RoB 2) was used for quality. Performed meta-analysis using Stata 15.0, with relative risk (RR) and 95% confidence interval (CI) as effect estimates. Results: Ten studies involving 7,703 Asia participants, mainly from China and Japan, were analyzed. The meta-analysis revealed that low-dose reduces the risk of bleeding (RR 0.51; 95% CI 0.27, 0.98) compared to standard dose, with similar risks for stroke (RR 1.04; 95% CI 0.69, 1.55), myocardial infarction (MI) (RR 1.91; 95% CI 0.88, 4.12), all-cause death (ACD) (RR 1.17; 95% CI 0.38, 3.62), and major bleeding (RR 0.74; 95% CI 0.16, 3.30). Subgroup analysis revealed that compared to standard-dose clopidogrel, low-dose clopidogrel increased the risk of MI. Notably, this increased risk was observed specifically within the Chinese population but not in the Japanese population. Low-dose clopidogrel and low-dose prasugrel reduce the risk of bleeding compared to standard-dose clopidogrel, but there is no statistically significant difference. Low-dose aspirin significantly reduces the risk of bleeding compared to standard-dose aspirin. Conclusion: In patients with stroke in Asia, low-dose antiplatelet therapy significantly reduces the risk of bleeding compared to standard doses, with consistent risks of stroke, MI, ACD, major bleeding, and discontinuation due to bleeding.

    Keywords: Low-dose, antiplatelet therapy, Stroke, Myocardial Infarction, bleeding, Meta-analysis

    Received: 29 Aug 2024; Accepted: 09 Dec 2024.

    Copyright: © 2024 Ren, Li, Zhang, Sun, Zhu, Wang, Wang, Liang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Chun-xing Li, Aerospace Center Hospital, Beijing, China
    Xin Zhang, Aerospace Center Hospital, Beijing, China
    Hui Zhu, Aerospace Center Hospital, Beijing, China
    Dongxiao Wang, Aerospace Center Hospital, Beijing, China
    Yumin Wang, Aerospace Center Hospital, Beijing, China
    Shuo Liang, Aerospace Center Hospital, Beijing, China
    Guanchun Wang, Aerospace Center Hospital, Beijing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.