Table 5.
GRADE evidence profile for PICO 6: long-term antiplatelet treatment (single or dual, duration, and whether any particular antiplatelet or combination of antiplatelets is better), compared to avoiding/less of/alternative antiplatelet intervention, to reduce recurrent ischaemic stroke, any stroke and MACE in patients with lacunar ischaemic stroke. Please compare with Figures 6-8.
| Certainty assessment | No of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Intervention | Comparator | Relative (95% CI) | Absolute (95% CI) | ||
| Any stroke (Antiplatelets vs placebo – other than Cilostazol) | ||||||||||||
| 1 | Randomised trials | Not serious | Not serious | Not serious | Not serious | None | 195/1919 (10.2%) | 93/681 (13.7%) | RR 0.74 (0.59, 0.94) |
36 fewer per 1000 (from 56 fewer to 8 fewer) |
⨁⨁⨁⨁ High |
CRITICAL |
| Any stroke (Cilostazol vs placebo) | ||||||||||||
| 1 | Randomised trials | Not serious | Not serious | Not serious | Serious a | None | 20/400 (5.0%) | 39/394 (9.9%) | RR 0.51 (0.30, 0.85) |
49 fewer per 1000 (from 69 fewer to 39 more) |
⨁⨁○○ Low |
CRITICAL |
| Any stroke (Antiplatelets vs Placebo – including Cilostazol) | ||||||||||||
| 2 | randomised trials | not serious | not serious | serious b | not serious | none | 215/2319 (9.3%) | 132/1075 (12.3%) | RR 0.69 (0.55, 0.88) |
38 fewer per 1000 (from 55 fewer to 15 fewer) |
⨁⨁⨁○ Moderate |
CRITICAL |
| Any stroke (Cilostazol added to other antiplatelets) | ||||||||||||
| 4 | Randomised trials | Not serious | Not serious | Not serious | Serious c | None | 27/784 (3.4%) | 44/759 (5.8%) | RR 0.74 (0.31, 1.75) |
15 fewer per 1000 (from 40 fewer to 43 more) |
⨁⨁⨁○ Moderate |
CRITICAL |
| Ischaemic stroke (Antiplatelets vs Placebo – including Cilostazol) | ||||||||||||
| 2 | Randomised trials | Serious d | Not serious | Serious | Not serious | None | 22/434 (5.1%) | 48/428 (11.2%) | RR 0.45 (0.25, 0.79) |
62 fewer per 1000 (from 84 fewer to 24 fewer) |
⨁⨁○○ Low |
CRITICAL |
| Ischaemic stroke (Cilostazol added to other antiplatelets) | ||||||||||||
| 4 | Randomised trials | Not serious | Not serious | Not serious | Serious c | None | 25/784 (3.2%) | 40/759 (5.3%) | RR 0.74 (0.30, 1.78) |
14 fewer per 1000 (from 37 fewer to 41 more) |
⨁⨁⨁○ Moderate |
CRITICAL |
| MACE Outcome (Antiplatelets vs placebo – other than Cilostazol) | ||||||||||||
| 1 | Randomised trials | Not serious | Not serious | Not serious | Not serious | None | 291/1919 (15.2%) | 128/681 (18.8%) | RR 0.81 (0.66, 0.98) |
38 fewer per 1000 (from 64 fewer to 4 fewer) |
⨁⨁⨁⨁ High |
CRITICAL |
| MACE Outcome (Aspirin + Dipyridamole vs Aspirin) | ||||||||||||
| 2 | randomised trials | not serious | not serious | not serious | serious e | none | 178/1346 (13.2%) | 207/1299 (15.9%) | RR 0.83 (0.69, 1.00) |
27 fewer per 1000 (from 49 fewer to 0 fewer) |
⨁⨁⨁○ Moderate |
CRITICAL |
| MACE Outcome (Cilostazol added to other antiplatelets) | ||||||||||||
| 2 | Randomised trials | Not serious | Not serious | Not serious | Serious f | None | 30/642 (4.7%) | 50/641 (7.8%) | RR 0.71 (0.20, 2.50) |
23 fewer per 1000 (from 62 fewer to 117 more) |
⨁⨁○○ Low |
CRITICAL |
CI: confidence interval; RR: risk ratio.
Explanations
Optimal information size not met (less event and small sample size).
Variation in interventions.
Wide confidence interval and clinical decision threshold crosses the line of no effect.
Included studies had some concern to high concern/high risk of bias.
Clinical decision threshold touches the line of no effect.
Wide confidence interval and clinical decision threshold crosses the line of no effect.