Comparison of Aspirin and P2Y12 Inhibitors for Secondary Prevention of Ischaemic Stroke: A Systematic Review and Meta-analysis.

Background: P2Y₁₂ inhibitors have been widely used as an alternative to aspirin in clinical practice for secondary stroke prevention. We aimed to compare the efficiency and safety of P2Y₁₂ inhibitors and aspirin for stroke prevention in patients with previous stroke or transient ischaemic attack (TIA).

Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched. All randomized trials that compared P2Y₁₂ inhibitors with aspirin among patients with stroke were included. The primary efficacy outcomes of our meta-analysis included stroke, vascular events, and all-cause death. The primary safety outcome was minor or major bleeding events.

Results: The search identified 4 randomized clinical trials comparing P2Y₁₂ inhibitors with aspirin for secondary stroke prevention that collectively enrolled 24508 patients (12253 received P2Y₁₂ inhibitor and 12255 received aspirin). Pooled results from the random-effects model showed that there were no significant differences in the risk of any stroke (OR 0.90 (0.78-1.04); I²=56.9%), vascular event (OR 0.91 (0.74-1.13); I²=78.3%), all-cause death (OR 0.98 (0.83-1.17); I²=0%), or minor or major bleeding (OR 1.13 (0.70-1.82); I²=79%) among patients who received a P2Y₁₂ inhibitor or aspirin. P2Y₁₂ inhibitors were associated with a significantly lower risk of recurrent ischaemic stroke (OR 0.84 (0.73- 0.96); I²=25%) than aspirin.

Conclusion: This meta-analysis suggests that P2Y₁₂ inhibitors are more effective than aspirin in preventing recurrent ischaemic stroke among ischaemic stroke patients despite the absence of any effect on a new ischaemic or haemorrhagic stroke, a new clinical vascular event, all-cause death, and major or minor bleeding events.