Comparing Efficacy and Safety of Dual Antiplatelet Therapy versus Intravenous Thrombolytics in Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis

Journal article : Review

Background: Acute minor ischemic stroke (AMIS) frequently results in significant disability despite current treatment options. This meta-analysis evaluated the effectiveness and safety of dual antiplatelet therapy (DAPT) compared to intravenous thrombolytics (IVT) in treating AMIS. Methods: PubMed, Cochrane Central, and ScienceDirect were searched till May 2025. Using a superiority framework, the risk ratios (RRs) along with 95% confidence intervals (CIs) were pooled under a random effects model using the Review Manager version 5.4.1. The quality assessment was done through the Cochrane Risk of Bias (RoB 2.0) and ROBINS-I tools. The primary and secondary outcomes assessed were functional (excellent and favourable) outcomes, symptomatic intracranial hemorrhage (sICH), recurrent ischemic strokes, all-cause mortality, and early neurological deterioration (END). Publication bias was evaluated via the funnel plots and Egger’s regression analysis. Results: Six studies pooling 7,366 AMIS patients were included in the meta-analysis. DAPT significantly reduced the END compared to IVT (RR = 0.50; 95%CI:[0.28, 0.89]; p = 0.02). The functional outcomes, including excellent (RR = 0.97; 95%CI:[0.87, 1.07]; p = 0.52) and favourable (RR = 1.00; 95%CI:[0.97, 1.03]; p = 0.97) functional outcomes, were comparable between DAPT and IVT. Likewise, the safety endpoints including sICH (RR = 0.27; 95%CI:[0.05, 1.38]; p = 0.12), recurrent ischemic strokes (RR = 0.89; 95%CI:[0.59, 1.34]; p = 0.59) and all-cause mortality (RR = 0.51; 95%CI:[0.21, 1.23]; p = 0.13) showed no significant difference between the two groups. Conclusion: DAPT is associated with lower END rates than IVT in AMIS management. Both groups showed similar efficacy regarding the functional outcomes. Safety outcomes, including sICH, recurrent stroke, and mortality, also showed no significant difference.

Authors: Waseem, MH; Abideen, ZU; Shahzad, F; Siddiqui, MR; Osama, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: Clinical and Applied Thrombosis/Hemostasis
• Volume: 32
• Article number: 10760296261450726
• Publication date: 2026-05-12
• Acceptance date: 2026-04-18
• DOI: 10.1177/10760296261450726
• EISSN: 1938-2723
• ISSN: 1076-0296
• Language: English
• Keywords: dual antiplatelet therapy; systematic review; intravenous thrombolysis; acute minor ischemic stroke; acute minor stroke; meta-analysis
• Subtype: Review