Efficacy And Safety Of Five Antiplatelet Drugs In The Treatment Of Acute Ischemic Stroke

Objective: Through systematically studying and evaluating the efficacy and safety of five antiplatelet drugs in the treatment of acute ischemic stroke by using mesh meta-analysis,references are provided for clinical treatment.Methods: According to the PICO principle,this study searched Pub Med,EMBASE,Cochrane Library,Web of science,China biomedical literature database,CNKI,Wanfang Data,VIP and other online electronic databases.The time was limited from January 2008 to December 2021,and the languages were Chinese and English.The literature was screened according to the inclusion and exclusion criteria,and the Review Manager 5 was applied 4 statistical software and ADDIS16.6 statistical software for statistical analysis.The effective outcome indicators were: effective rate,National Institute of Health Stroke Scale(NIHSS),Barthel scale(Barthel),platelet aggregation rate;The safety outcome indicators were: stroke(including ischemic stroke and hemorrhagic stroke),other hemorrhagic events,death,and other adverse events(dizziness,gastrointestinal reactions,subcutaneous ecchymosis).Results: 28 literatures were finally included in this study,including 11 in China and 17 abroad.All of them were randomized controlled trials,with a total of 62521 patients.(1)EfficacyA total of 11 studies were included in the effective rate.The results showed that the effective rate of the experimental group was higher than that of the control group(MD = 4.18,95% CI = 2.9 ~ 25.98,P < 0.00001).Mesh meta-analysis showed that compared with the control group,cilostazol(MD = 0.25,95% CI = 0.11 ~ 0.59),cilostazol + aspirin(MD = 0.39,95% CI = 0.18 ~ 0.85),clopidogrel(MD = 0.13,95% CI = 0.02 ~ 1.08),clopidogrel + aspirin(MD = 0.22,95% CI = 0.13 ~ 0.37)and tegrilol(MD = 0.14,95% CI = 0.04 ~ 0.50)could improve the treatment efficiency.The results of probability ranking showed that clopidogrel had the best effect on ischemic stroke.NIHSS score was included in 8 studies.The results showed that the NIHSS score of the experimental group was significantly lower than that of the control group(MD =-4.73,95% CI =-6.08 ~-2.67,P < 0.00001).Mesh meta-analysis showed that cilostazol(MD = 3.07,95% CI =-13.9 ~ 19.33),clopidogrel(MD = 5.19,95% CI = 4.03 ~ 6.35)and clopidogrel + aspirin(MD = 4.65,95% CI = 2.19 ~ 7.11)could reduce NIHSS score compared with the control group.The results of probability ranking showed that clopidogrel + aspirin had the best effectBarthel score was included in four studies.The results showed that compared with the control group,the Barthel score in the experimental group was significantly higher(MD = 14.42,95% CI = 12.14 ~ 16.70,P < 0.00001).Platelet aggregation rate was included in 4 studies.Compared with the control group,the platelet aggregation rate of the experimental group(MD =-3.89,95% CI =-11.92 ~ 4.12,P = 0.34)was not statistically significant.(1)Safetystroke was included in 11 studies were.The results showed that compared with the control group,the incidence of stroke in the experimental group decreased(MD = 0.82,95% CI = 0.77 ~ 0.88),P < 0.00001).Mesh meta-analysis showed that compared with the control group,cilostazol + aspirin(MD = 5.19,95% CI = 4.03 ~ 6.35),clopidogrel + aspirin(MD = 5.19,95% CI = 4.03 ~ 6.35),dipyridamole + aspirin(MD = 5.19,95% CI = 4.03 ~ 6.35),sagrel(MD = 5.19,95% CI = 4.03 ~ 6.35),tigrelol(MD = 5.19,95% CI = 4.03 ~ 6.35)Ticagrelor + aspirin(MD = 5.19,95% CI = 4.03 ~ 6.35)can reduce the incidence of stroke.The probability ranking results showed that cilostazol + aspirin had the best effect.Hemorrhagic events were included in 11 studies.The results showed that compared with the control group,the hemorrhagic events in the experimental group(MD = 1.34,95% CI = 0.32 ~ 1.77,P = 0.5)were not statistically significant.Mesh meta-analysis showed that compared with the control group,cilostazol(MD = 0.50,95% CI = 0.05 ~ 5.51),clopidogrel + aspirin(MD = 0.86,95% CI = 0.46 ~ 1.62),dipyridamole + aspirin(MD = 0.68,95% CI = 0.27 ~ 1.67),sagrel(MD = 0.64,95% CI = 0.45 ~ 0.90),tigrelol(MD = 1.09,95% CI = 0.71 ~ 1.68)and tigrelol + aspirin(MD = 0.34,95% CI = 0.21 ~ 0.57)had fewer hemorrhagic events.The results of probability ranking showed that dipyridamole had the least hemorrhagic eventsDeath was included in 10 studies.The results showed that compared with the control group,the death in the experimental group(MD = 1.09,95% CI = 0.93 ~ 1.29,P = 0.28)was not statistically significant.Mesh meta-analysis showed that compared with the control group,there were fewer deaths in clopidogrel + aspirin(MD = 1.24,95% CI = 0.79 ~ 1.97),dipyridamole + aspirin(MD = 2.59,95% CI = 0.81 ~ 8.29),sagrel(MD = 0.93,95% CI = 0.68 ~ 1.28),tigrelol(MD = 0.84,95% CI = 0.66 ~ 1.07),tigrelol + aspirin(MD = 0.75,95% CI = 0.46 ~ 1.24).The results of probability ranking showed that the death rate of dipyridamole + aspirin was the lowest.Adverse reaction events were included in 8 studies.The results showed that compared with the control group,the adverse reactions in the test group(MD = 0.88,95% CI = 0.61 ~ 1.25,P = 0.47)were not statistically significant.Mesh meta-analysis showed that cilostazol(MD = 1.04,95% CI = 0.59 ~ 1.85),clopidogrel(MD = 0.96,95% CI = 0.33 ~ 2.76),clopidogrel + aspirin(MD = 0.96,95% CI = 0.33 ~ 2.76),tigritol(MD = 0.84,95% CI = 0.66 ~ 1.07)and tigritol + aspirin(MD = 1.36,95% CI = 0.29 ~ 6.43)could reduce the incidence of adverse events compared with the control group.The probability ranking results showed that the adverse reaction rate of cilostazol was the lowest.Conclusion: This study shows that in the treatment of acute ischemic stroke with five antiplatelet drugs,the treatment effect of the experimental group is more significant than that of the control group.In the mesh meta-analysis,clopidogrel was effective in the effective rate and NIHSS score;Cilostazol had the lowest incidence of stroke and adverse reaction events,and dipyridamole had the lowest incidence of hemorrhagic events and death.