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. 2018 Dec 18;363:k5108. doi: 10.1136/bmj.k5108

Table 3.

GRADE evidence profile: Dual antiplatelet with clopidogrel and aspirin for 10-21 days versus 22-90 days after transient ischaemic attack (TIA) or minor stroke

Outcome; timeframe Study results and measurements Absolute effect estimates Certainty in effect estimates (quality of evidence) Plain text summary
Stop clopidogrel, continue aspirin Continue clopidogrel and aspirin
Ischaemic stroke; 90 days Odds ratio 1.47 (95% CI 0.84 to 2.56). Based on data from 4406 patients in one study. Follow-up 90 days 10/1000 14/1000 Moderate: due to indirectness* Longer duration of dual antiplatelet therapy probably does not result in an important reduction in ischaemic stroke
Difference: 4 more per 1000 (95% CI 2 fewer to 11 more)
Moderate or severe bleeding; 90 days Odds ratio 2.20 (95% CI 0.83 to 5.78). Based on data from 4599 patients in one study. Follow-up 90 days 3/1000 6/1000 High: downgraded due to imprecision and upgraded due to a dose-response gradient † Longer duration of dual antiplatelet therapy increases risk of moderate or major bleeding by small amount
Difference: 3 more per 1000 (95% CI 1 fewer to 7 more)
*

Indirectness: serious. Patients were randomised 21 days before decision point of whether to stop clopidogrel or not, and patients who had a stroke within the first 21 days were not included in this analysis. More patients randomised to aspirin had a stroke before day 21. Therefore, patients who continued clopidogrel and aspirin were probably at higher risk of a stroke after day 21.

Imprecision: serious. Confidence interval includes no difference.