Review: anticoagulants are not more effective than antiplatelet agents in acute ischemic stroke.

In patients with acute ischemic stroke, what is the comparative effectiveness of anticoagu-lants (alone or with antiplatelet agents) and antiplatelet agents alone given within 14 days of stroke onset? D a t a s o u r c e s Studies were selected if they were randomized controlled trials comparing anticoagulants with antiplatelet agents, or anticoagulants plus antiplatelet agents with antiplatelet agents alone, given within 14 days of onset of presumed or confirmed acute ischemic stroke. Studies were excluded if treatment allocation was not adequately concealed or if they only assessed patients with transient ischemic attacks. D a t a e x t r a c t i o n Data were extracted on study methods and quality, participants, interventions, and outcomes. 4 trials (data from 16 558 patients; most had had nonhemorrhagic strokes and were aged > 70 y) were included. Data from 11 721 patients contributed to the comparison of anticoagulants with antiplatelet agents, and data from 9720 patients contributed to the comparison of anticoagulants plus anti-platelet agents with antiplatelet agents alone. All trials included patients within 48 hours of stroke onset. Follow-up was at 10 days in 1 trial, 3 months in 1 trial, and 6 months in 2 trials. The anticoagulants used were unfrac-tionated heparin and low-molecular-weight heparin; aspirin was used as the control in all trials; treatments lasted for 10 to 14 days. Anticoagulants with or without aspirin compared with aspirin alone did not reduce death or dependence at the end of follow-up; however, anticoagulants were associated with a trend toward increased risk for death at the end of follow-up and symptomatic intracra-nial hemorrhage during treatment (Table). In patients with acute ischemic stroke, anti-coagulants used alone or with antiplatelet agents are not superior to antiplatelet agents used alone. Anticoagulants (AC) alone or with antiplatelet agents (AP) vs AP alone at end of follow-up (10 d to 6 mo) or during treatment (treatment durations 10 to 14 d)*