Summary of findings 3. Dual antiplatelet therapy compared to single antiplatelet therapy for prevention of cognitive decline and dementia in people with cerebral small vessel disease and no dementia.
| Dual antiplatelet therapy compared to single antiplatelet therapy for prevention of cognitive decline and dementia in people with cerebral small vessel disease and no dementia | |||
| Patient or population: people with cerebral small vessel disease and no dementia Setting: outpatient services Intervention: dual antiplatelet therapy Comparison: single antiplatelet therapy | |||
| Outcomes | Impact | № of participants (studies) | Certainty of the evidence (GRADE) |
| Change in cognitive function from baseline assessed with CASI score | 1 trial reported no beneficial effect of additional antiplatelet treatment over placebo on cognitive functioning assessed with the CASI score. | 3020 (1 RCT) | ⊕⊕⊝⊝ Lowa,b |
| Incident dementia | No trials reported this outcome | — | — |
| Major bleeding (intracranial and extracranial) | 1 trial reported a difference in major haemorrhagic events (105/1517 participants with intervention vs 56/1503 participants with control; HR 1.97, 95% CI 1.41 to 2.71) | 3020 (1 RCT) | ⊕⊕⊝⊝ Lowa,b |
| Functional ability | No trials reported this outcome. | — | — |
| Stroke or transient ischaemic attack | 1 trial reported there was probably no effect of additional antiplatelet treatment on stroke or TIA | 3020 (1 RCT) | ⊕⊕⊝⊝ Lowa,b |
| Any adverse events (excluding major bleeding) | No trials reported this outcome. | — | — |
| Withdrawal from study medication | 1 trial reported an increase in medication withdrawal in those taking additional antiplatelets in comparison to those taking a placebo (30% with intervention vs 27% with control; P = 0.02). | 3020 (1 RCT) | ⊕⊕⊝⊝ Lowa,b |
| *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). CASI: Cognitive Abilities Screening Instrument; CI: confidence interval; HR: hazard 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. | |||
aDowngraded one level for imprecision as only one study contributed to this finding. bDowngraded one level for indirectness because most participants had mild cognitive impairment at baseline, making it difficult to translate these findings to the general small‐vessel disease population.