Anticoagulants versus Antiplatelet agents for acute Ischemic Stroke: Systematic Review and Meta-analysis

Abstract

Background: Acute ischemic stroke is a primary etiology of mortality and morbidity globally, and prompt treatment with antiplatelet or anticoagulants medications is essential for enhancing results.
Aim: This meta-analysis aimed to evaluate the safety & efficacy of anticoagulants compared to antiplatelet medicines in the managing of acute ischemic stroke.
Methods: A search of PubMed, Embase, Cochrane Library, and Google Scholar identified studies with key words as: Anticoagulants, acute ischemic stroke, Antiplatelet agents, venous thromboembolism and recurrent ischemic stroke. Additional searches were done on ClinicalTrials.gov and relevant references were reviewed.
Results: The meta-analysis, including three research with a total of 6,242 participants, found insignificant differences between anticoagulants and antiplatelet agents in preventing venous thromboembolism (RR 0.58, ninety-five percent confidence interval 0.05–6.95, p = 0.6), hypertension (RR 0.98, ninety-five percent confidence interval 0.88–1.09, p = 0.7), or recurrent ischemic stroke within fourteen days (RR 1.1, ninety-five percent confidence interval 0.69–1.75, p = 0.6). Mortality rates were comparable (RR 1.19, ninety-five percent confidence interval 0.76–1.86, p = 0.4), as was long-term death or dependency (RR 1.02, ninety-five percent confidence interval 0.98–1.06, p = 0.3). Subgroup analysis suggested that the combination of small-dose unfractionated heparin and aspirin may provide net advantages compared to aspirin only.
Conclusion: The meta-analysis study found no clear advantage among antiplatelet and anticoagulants agents in preventing venous thromboembolism, hypertension, frequent ischemic stroke, mortality, or long-term death in acute ischemic stroke cases.