Impact of Dual Antiplatelet Therapy Versus Monotherapy in Acute Stroke Management: A Systematic Review

TL;DR

This study compares the effectiveness of using two antiplatelet drugs together versus one drug alone in treating acute stroke and finds that dual therapy reduces stroke recurrence without increasing bleeding risks.

Contribution

The study provides new evidence that dual antiplatelet therapy improves outcomes in acute stroke and highlights the role of genetic factors in treatment efficacy.

Findings

Dual antiplatelet therapy (DAPT) significantly reduces stroke recurrence compared to monotherapy.

DAPT improves functional outcomes without increasing major bleeding risk.

Genetic polymorphisms like CYP2B6 variants influence DAPT efficacy, suggesting potential for personalized treatment.

Abstract

This systematic review evaluates the comparative efficacy and safety of dual antiplatelet therapy (DAPT) versus monotherapy in the management of acute ischemic stroke and transient ischemic attack (TIA). Six studies, published between 2019 and 2024, were included, focusing on patient outcomes such as stroke recurrence, functional recovery, and safety measures. The findings consistently demonstrated that DAPT, particularly combinations like aspirin with clopidogrel or cilostazol, significantly reduced stroke recurrence and improved functional outcomes as compared to monotherapy, without a notable increase in major bleeding risk. Timing and duration of therapy were identified as critical factors, with early initiation and prolonged DAPT showing promising results in high-risk populations, including those with intracranial arterial stenosis or large artery atherosclerosis. Genetic polymorphisms, such as CYP2B6 variants, further influenced treatment efficacy, highlighting the potential for personalized therapeutic approaches. While the evidence underscores the clinical value of DAPT, it also identifies gaps such as the need for real-world studies and investigations into long-term safety. This review contributes to advancing stroke management by providing a nuanced, evidence-based perspective on the role of DAPT in reducing vascular events and disability.