Summary of findings 1. Antiplatelet drug compared to control in acute presumed ischaemic stroke for acute ischaemic stroke.
| Antiplatelet drug compared to control in acute presumed ischaemic stroke for acute ischaemic stroke | |||||
| Patient or population: acute ischaemic stroke Setting: secondary care Intervention: antiplatelet drug Comparison: control in acute presumed ischaemic stroke | |||||
| Outcomes | No of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with control in acute presumed ischaemic stroke | Risk difference with antiplatelet drug | ||||
| Death or dependence at end of follow‐up (primary outcome) | 42,034 (7 RCTs) | ⊕⊕⊕⊝ Moderatea,b | Peto OR 0.95 (0.91 to 0.99) | Study population | |
| 458 per 1000 | 13 fewer per 1000 (23 fewer to 2 fewer) | ||||
| Death from any cause during follow‐up | 41,929 (10 RCTs) | ⊕⊝⊝⊝ Very lowa,c,d | Peto OR 0.93 (0.87 to 0.98) | Study population | |
| 128 per 1000 | 8 fewer per 1000 (15 fewer to 2 fewer) | ||||
| Pulmonary embolism during treatment period | 41,042 (7 RCTs) | ⊕⊝⊝⊝ Very lowa,e,f,g | Peto OR 0.71 (0.53 to 0.96) | Study population | |
| 5 per 1000 | 1 fewer per 1000 (2 fewer to 0 fewer) | ||||
| Recurrent ischaemic/unknown stroke during treatment period | 41,652 (9 RCTs) | ⊕⊝⊝⊝ Very lowa,c,d | Peto OR 0.79 (0.70 to 0.88) | Study population | |
| 32 per 1000 | 7 fewer per 1000 (9 fewer to 4 fewer) | ||||
| Symptomatic intracranial haemorrhage during treatment period | 41,652 (9 RCTs) | ⊕⊝⊝⊝ Very lowa,c,h,i | Peto OR 1.18 (0.97 to 1.44) | Study population | |
| 9 per 1000 | 2 more per 1000 (0 fewer to 4 more) | ||||
| Major extracranial haemorrhage during treatment period | 41,042 (7 RCTs) | ⊕⊝⊝⊝ Very lowa,e,i | Peto OR 1.69 (1.35 to 2.11) | Study population | |
| 6 per 1000 | 4 more per 1000 (2 more to 6 more) | ||||
| Complete recovery from stroke (post hoc) | 40,541 (2 RCTs) | ⊕⊕⊕⊝ Moderatea,j | Peto OR 1.06 (1.01 to 1.11) | Study population | |
| 262 per 1000 | 11 more per 1000 (2 more to 21 more) | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PetoOR: Peto odds ratio; RCT: randomised controlled trial. | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aThe CAST study included only participants of Chinese ethnicity and contributed almost 50% of the data in the meta‐analysis. Therefore, the results are mainly applicable to a Chinese population. bDeath or dependence is the primary outcome measure for the majority of acute stroke intervention trials. cTwo studies were at high risk of bias, for one study there was no information on risk of bias, and for one study the risk of bias was unclear. dStudies showed variable results (some increased, reduced or no change in the event). Therefore, results were not consistent between studies, although there was overlap in the confidence intervals and heterogeneity was low (I2 < 25%). eOne study was at high risk of bias, one study was at unclear risk of bias, and for one study information on risk of bias was not available. fThe analysis was based on two small studies and the confidence intervals were wide. gDeep vein thrombosis and pulmonary embolism are important complications following acute stroke, but secondary to death or dependence. hRecurrent stroke and symptomatic intra‐ or extra‐cranial haemorrhage were a commonly reported outcome measures but are secondary to death or dependence. iThe confidence intervals were wide, but data were from two large studies. jComplete recovery from stroke is an important outcome, reported in the two largest trials in this review, but remains secondary to death or dependence which is the most commonly reported outcome measure.