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Oral antiplatelet therapy for acute ischaemic stroke

  1. Peter AG Sandercock1,*,
  2. Carl Counsell2,
  3. Mei-Chiun Tseng3,
  4. Emanuela Cecconi1

Editorial Group: Cochrane Stroke Group

Published Online: 26 MAR 2014

Assessed as up-to-date: 24 OCT 2013

DOI: 10.1002/14651858.CD000029.pub3


How to Cite

Sandercock PAG, Counsell C, Tseng MC, Cecconi E. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD000029. DOI: 10.1002/14651858.CD000029.pub3.

Author Information

  1. 1

    University of Edinburgh, Division of Clinical Neurosciences, Edinburgh, UK

  2. 2

    University of Aberdeen, Division of Applied Health Sciences, Aberdeen, UK

  3. 3

    National Sun Yat-Sen University, Department of Business Management, Kaohsiung, Taiwan, China

*Peter AG Sandercock, Division of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. peter.sandercock@ed.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 26 MAR 2014

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
CAST 1997 {published and unpublished data}
  • CAST (Chinese Acute Stroke Trial) Collaborative Group. A randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 1997;349:1641-9.
Ciufetti 1990 {published and unpublished data}
  • Ciuffetti G, Aisa G, Mercuri M, Lombardini R, Paltriccia R, Neri C, et al. Effects of ticlopidine on the neurologic outcome and the hemorheologic pattern in the postacute phase of ischemic stroke: a pilot study. Angiology 1990;41:505-11.
IST 1997 {published and unpublished data}
  • International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 1997;349:1569-81.
MAST-I 1995 {published and unpublished data}
  • Multicentre Acute Stroke Trial-Italy (MAST-I) Group. Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 1995;346:1509-14.
Pince 1981 {unpublished data only}
  • Pince J. Thromboses veineuses des membres inferieures et embolies pulmonaires au cours des accidents vasculaires cerebraux. A propos d'un essai comparatif de traitment preventif. (These pour le doctorat d'etat en medicine). Toulouse: Universite Paul Sabatier, 1981.
Rödén-Jüllig 2003 {published data only}
Turpie 1983 {unpublished data only}
  • Turpie AGG, Dobkin B, McKenna R. A trial of ticlopidine, an antiplatelet agent, for acute cerebral infarction. Guildford: Sanofi Winthrop (Sanofi internal report 1983.001.6.188) 1983.
Utsumi 1988 {unpublished data only}
  • Utsumi H. Evaluation of utility of ticlopidine, an antiplatelet agent, for acute cerebral infarction. Guildford: Sanofi Winthrop (Sanofi internal report 001.6.128) 1984.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Abciximab 2000 {published data only}
AbESTT 2005 {published data only}
  • Abciximab Emergent Stroke Treatment Trial (AbESTT) Investigators. Emergency administration of abciximab for treatment of patients with acute ischemic stroke. Results of a randomized phase 2 trial. Stroke 2005;36:880-90.
AbESTT-II/C 2008 {published data only}
  • Adams HP Jr, Effron MB, Torner J, Davalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke 2008;39:87-99.
AbESTT-II/P 2008 {published data only}
  • Adams HP Jr, Effron MB, Torner J, Davalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke 2008;39:87-99.
AbESTT-II/W 2008 {published data only}
  • Adams HP Jr, Effron MB, Torner J, Davalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke 2008;39:87-99.
Aoki 2000 {unpublished data only}
  • Aoki T. Prolonged administration of ticlopidine to cerebral infarction. Unpublished. [Cochrane Stroke Group Trials Register ID 3461]
APLAUD 2000 {published data only}
  • Harrington RA, Armstrong PW, et al. for the Anti-PLAtelet Useful Dose (APLAUD) Study Investigators. Dose-finding, safety, and tolerability study of an oral platelet glycoprotein IIb/IIIa inhibitor, lotrafiban, in patients with coronary or cerebral atherosclerotic disease. Circulation 2000;102:728-35. [MEDLINE: 20402310]
Apollonia 1989 {published data only}
  • Apollonia A, Castignani P, Magrini L, Angeletti R. Ticlopidine-pentoxiphylline combination in the treatment of atherosclerosis and the prevention of cerebrovascular accidents. Journal of International Medical Research 1989;17:28-35.
ARTIS 2012 {published data only}
Balkuv-Ulutin 1989 {published data only}
  • Balkuv-Ulutin S, Hacihanifioglu M, Ulutin UN. Clinical and laboratory results obtained with defibrotide in the case of acute stroke. Thrombosis and Haemostasis 1989;62:585.
BRAVO 2000 {published data only}
  • Topol EJ, Easton JD, Amarenco P, Califf R, Harrington R, Graffagnino C, et al. Design of the blockade of the glycoprotein IIb/IIIa receptor to avoid vascular occlusion (BRAVO) trial. American Heart Journal 2000;139:927-33. [MEDLINE: 20287265]
Chen 1988 {published data only}
  • Chen J, Ye M, Wei J. Hemorrheological study on the effect of acupuncture in treating cerebral infarction. Journal of Traditional Chinese Medicine 1988;8:167-72. [Cochrane Stroke Group Trials Register id 4731]
Cheung 2000 {published data only}
CLEAR trial {published data only}
  • Pancioli A, for the CLEAR Trial Investigators. The combined approach to lysis utilizing eptifibatide and rt-PA in acute ischemic stroke (the CLEAR stroke trial): blinded results from tier I and II. Proceedings of the International Stroke Conference; 2006 February 16-18; Kissimmee (FL), USA. 2006:(Abstract CTP17).
  • Pancioli AM, Broderick JP, the CLEAR Stroke Trial Investigators. The combined approach to lysis utilizing eptifibatide and rt-PA in acute ischemic stroke (The CLEAR Stroke Trial). Proceedings of the 29th International Stroke Conference; 2004 February 5-7; San Diego (CA), USA. 2004:(Abstract CTP16).
D'Andrea 1993 {published data only}
  • D'Andrea G, Cananzi AR, Alecci M, Perini F, Zamberlan F, Milone FF. Study of effect of picotamide, ASA, and picotamide plus ASA on platelet aggregation in ischemic stroke. Canadian Journal of Neurological Sciences 1993;20 Suppl 4:s23.
  • D'Andrea G, Perini F, Hasselmark L, Alecci M, Cananzi AR. Effect of picotamide and aspirin, combined or alone, on platelet aggregation in patients with cerebral infarction. Functional Neurology 1995;10:91-8.
Fan 2003 {published data only}
  • Fan DL. Clinical research of ligustrazine for acute cerebral infarction. Chinese Journal of Hemorheology 2003;13:250.
FASTER 2007 {published data only}
  • Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM, et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurology 2007;6:961-9.
Gao 1989 {published data only}
  • Gao B, Hu ZX, Li CM. The effect of ligustrazine, aspirin and betahistine on the platelet aggregation of ischemic stroke patients. Chinese Journal of Neurology and Psychiatry 1989;22:148-51. [Cn-00280553]
Garcia Tigera 1994 {published data only}
  • Garcia Tigera J, Martinez Dreke R. Levamisol, a new treatment for cerebral infarction [Abstract]. Journal of Neurology 1994;241 Suppl 1:S162.
Hakim 1984 {published data only}
  • Hakim AM, Pokrupa RP, Wolfe LS. Preliminary report on the effectiveness of prostacyclin in stroke. Canadian Journal of Neurological Sciences 1984;11:409.
Iida 1984 {unpublished data only}
  • Iida N. Clinical experience with ticlopidine in patients with cerebral infarction. Unpublished data 1984.
JASAP 2011 {published data only}
  • Uchiyama S, Ikeda Y, Urano Y, Horie Y, Yamaguchi T. The Japanese aggrenox (extended-release dipyridamole plus aspirin) stroke prevention versus aspirin programme (JASAP) study: a randomized, double-blind, controlled trial. Cerebrovascular Diseases 2011;31:601-13. [DOI: 10.1159/000327035]
Joseph 1989 {published data only}
Junghans 2002 {published data only}
Kamath 2001 {published data only}
  • Kamath S, Lip GY. YM-337 Yamanouchi. Current Opinion in Investigational Drugs 2001;2:1093-6.
Kaye 1989 {unpublished data only}
  • Kaye J. A trial to evaluate the relative roles of dipyridamole and aspirin in the prevention of deep vein thrombosis in stroke patients. Brackness (UK): Boehringer Ingelheim (Internal report trial no. CT 330/189) 1989.
Lecrubier 1977 {published data only}
Li 1999 {published data only}
  • Li SH, Li DY, Wang YJ, Guo H, Cheng CY, Zhao J. Study of optimal aspirin loading and maintaining dosage for cerebral infarction at acute stage. Chinese Journal of Neurology 1999;32:302. [Cn-00282304]
Li 2005 {published data only}
  • Li GY, Lin YX, Zhou Y, Song LF, Li BC. Effect of ozagrel sodium in ameliorating the motor function of patients with acute lacunar infarct of dyskinesias: A randomized, double-blind, placebo-controlled trial. Chinese Journal of Clinical Rehabilitation 2005;9:4-5.
Liu 1994 {published data only}
  • Liu X, Li X, Miao L, Wang Q, Bao L. Therapeutic observation and biochemical study of calcium antagonist and anti-thromboxane A2 activity in acute ischaemic stroke. Journal of Apoplexy and Nervous Diseases 1994;11:72-4.
Matsumoto 2005 {published data only}
  • Matsumoto Y. Comparison of the effects between ozagrel Na combined with cilostazol and ozagrel Na alone for acute phase ischemic stroke in the territory of perforating arteries of the MCA: a randomized open trial. UMIN Clinical Trials Registry. center.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi (accessed 8 August 2007).
Monreal 1987 {published data only}
  • Monreal M, Lafoz E, Foz M, Monasterio J. Aspirin and the kidney in patients with cerebral ischemia. Thrombosis and Haemostasis 1987;58:548.
Ohtomo 1991 {published data only}
  • Ohtomo E, Kutsuzawa T, Kogure K, Hirai S, Goto F, Terashi Am Tazaki Y, et al. Clinical usefulness of OKY-046 on the acute stage of cerebral thrombosis - double blind trial in comparison with placebo. Rinsho Iyaku (Journal of Clinical Therapeutics and Medicine) 1991;7:353-88.
SaTIS 2011 {published data only}
Seitz 2004 {published data only}
Siebler 2003 {published data only}
TACS 2000 {unpublished data only}
  • Marini C, Rothwell P, Di Orio F, Maragliano E. Efficacy and safety of ticlopidine and aspirin versus aspirin alone in the prevention of vascular events after cerebral ischaemia. Unpublished 2000.
TARDIS {published data only}
  • Bath P. Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke (TARDIS) http://www.controlled-trials.com/ISRCTN47823388. http://www.tardistrial.org/.
Wu 2005 {published and unpublished data}
  • Bo W, Ming L, Song T. A randomized controlled trial of ligustrazine for acute ischemic stroke. Journal of the Neurological Sciences 2005;238 Suppl 1:S415.
Yan 1998 {published data only}
  • Yan FL, Xu YM, Ma JM. Clinical investigation of ticlopidine hydrochloride in the treatment of cerebral infarction. Chinese Journal of Practical Internal Medicine 1998;18:657.
Zhang 2005 {published data only}
  • Zhang D, Zhu S, Cui G, Li Y, Zhang H, Xia Z, Ren W. Clinical study of low-molecular-weight heparin calcium and aspirin therapy on acute cerebral infarction. Chinese Pharmaceutical Journal 2005;40:634-6.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Fujimoto 2010 {published data only}
  • Fujimoto S, Jinnouchi J, Inoue T, Suzuki S, Sadoshima S. Effect of combined antithrombotic treatment with cilostazol for progressive stroke. International Journal of Stroke 2010;5 Suppl 2:87-8.
Wang 2000 {published data only}
  • Wang C, Wang Y, Gao Y. Randomized placebo-controlled trial of early aspirin used in 180 patients with acute ischaemic stroke in the elderly people. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease 2000;8:19-21.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
CAIST-J 2006 {published data only}
  • Suzuki N. Cilostazol in Acute Ischemic Stroke Trial. UMIN Clinical Trials Registry (UMIN-CTR). (http://www.umin.ac.jp/ctr/) 2006.
CAPS 2009 {published data only}
  • Tominaga T. A randomized clinical trial of an antiplatelet agent in the treatment of acute stroke: cilostazol in the prevention of acute progressing stroke (CAPS) study. UMIN Clinical Trials Registry (UMIN-CTR) (http://www.umin.ac.jp/ctr/) 2009.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
AbESTT-II
  • Adams HP Jr, Effron MB, Torner J, Davalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke 2008;39:87-99.
AHA 2013
ATC 1994a
  • Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy - I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81-106.
ATC 1994b
  • Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy - III: Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. BMJ 1994;308:235-46.
ATC 2002
  • Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high-risk patients. BMJ 2002;324:71-86.
ATC 2009
  • Antithrombotic Trialists’ Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
Bamford 1989
  • Bamford J, Sandercock P, Warlow C, Slattery J. Inter-observer agreement for the assessment of handicap in stroke patients. Stroke 1989;20:8.
Bath 2004a
  • Bath PMW. Prostacyclin and analogues for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD000177.pub2]
Bath 2004b
  • Bath PMW, Bath-Hextall FJ. Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD000162.pub2]
CAIST 2011
Candelise 1994
Chairangsarit 2005
  • Chairangsarit P, Sithinamsuwan P, Niyasom S, Udommongkol C, Nidhinandana S, Suwantamee J. Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study. Journal of the Medical Association of Thailand 2005;88:S148–S154.
CHANCE 2013
Chen 2000
  • Chen ZM, Sandercock P, Pan HC, Counsell C, Collins R, Liu LS, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40,000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. On behalf of the CAST and IST Collaborative Groups. Stroke 2000;31:1240-9.
Ciccone 2006
Collins 1996
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CSS 2010
  • Canadian Stroke Network and Heart and Stroke Foundation of Canada. Canadian Best Practice Recommendations for Stroke Care: Update 2010. http://www.canadianstrokenetwork.ca/ December 2010.
Dalen 2006
Davenport 1996
Dennis 1997
EARLY 2010
  • Dengler R, Diener HC, Schwartz A, Grond M, Schumacher H, Machnig T, EARLY Investigators. Early treatment with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke within 24 h of symptom onset (EARLY trial): a randomised, open-label, blinded-endpoint trial. Lancet Neurology 2010;9:159-66. [DOI: 10.1016/S1474-4422(09)70361-8]
ESO 2008
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Hankey 2010
Higgins 2011
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IST 1996
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Jauch 2013
  • Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947. [DOI: 10.1161/STR.0b013e318284056a]
Kamal 2012
  • Kamal AK, Siddiqi SA, Naqvi I, Khan M, Majeed F, Ahmed B. Multiple versus one or more antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD009716]
Keir 2002
  • Keir S, Wardlaw J, Sandercock PAG, Chen Z. Antithrombotic therapy in patients with any form of intracranial haemorrhage: a systematic review of the available controlled studies. Cerebrovascular Diseases 2002;14(3-4):197-206.
MedStrategy 1995
  • Dick E. Stroke: A focus of opportunity. St. Louis, USA: MedStrategy, 1995.
Murray 1997
Murray 2012
  • Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-223.
NINDS 1995
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Odgaard-Jensen 2011
Patrono 1994
Patrono 1998
POINT
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RCP Guideline 2012
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RevMan 2012 [Computer program]
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Ricci 2012
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Strong 2007
Suri 2008
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SUTC 2013
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Tsai 2013
van Gijn 1992
van Kooten 1994
van Kooten 1997
Wardlaw 2009
Warlow 2001
  • Warlow C. Stroke, transient ischaemic attacks, and intracranial venous thrombosis. In: Donaghy M editor(s). Brain's Diseases of the Nervous System. 11th Edition. Oxford University Press, 2001:775-896.
Zhang 2012

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Sandercock 2003
  • Sandercock P, Gubitz G, Foley P, Counsell C. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD000029]