Efficacy of antiplatelet therapy for treating lacunar infarct: Meta-analysis

Objective To evaluate the efficacy of antiplatelet agents in secondary prevention of patients with lacunar infarct (LACI). Methods Retrieve relevant randomized controlled trials (RCTs) that reported antiplatelet therapy in patients with LACI from online databases (January 1, 1980-November 20, 2016) in PubMed, EMBASE/SCOPUS and Cochrane Online Library with key words: stroke, lacunar infarction, platelet aggregation inhibitors, antiplatelet, randomized controlled trial. Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions. All data were pooled by RevMan 5.3 software for Meta-analysis. A network Meta-analysis was done by R software Gemtc and JAGS software. Results A total of 4068 articles were enrolled and 12 high - quality RCTs (Jadad ≥ 4 scores) with 24 969 eligible participants were finally included after excluding duplicates and those not meeting the inclusion criteria. Meta-analysis showed single antiplatelet therapy was more effective than placebo in reducing ischemic stroke recurrence rate ( RR = 0.480, 95%CI: 0.300-0.780; P = 0.003) and any stroke recurrence rate ( RR = 0.780, 95%CI: 0.630-0.970; P = 0.030). The efficacy of single antiplatelet therapy was not significantly different from that of dual antiplatelet therapy (ischemic stroke recurrence rate: RR = 0.900, 95%CI: 0.760-1.050, P = 0.170; any stroke recurrence rate: RR = 0.910, 95%CI: 0.820-1.010, P = 0.070). Network Meta-analysis (four interventions including aspirin, placebo, cilostazol and ticlopidine) showed that cilostazol was associated with a significant reduction in recurrence of any stroke compared with aspirin ( OR = 0.341, 95% CrI: 0.011-0.673) and placebo ( OR = 0.615, 95% CrI: 0.191-1.042). Conclusions Single antiplatelet therapy could significantly reduce the recurrence of any stroke, especially ischemic stroke in patients with LACI. There is no evidence showing that dual antiplatelet therapy is probably better than single therapy. Cilostazol is better than aspirin in reducing any stroke recurrence in the treatment of LACI. DOI: 10.3969/j.issn.1672-6731.2017.03.004