Abstract 4371139: Dual Antiplatelet Therapy post Intravenous Thrombolysis in patients with Minor Ischemic Stroke: A Systematic Review and Meta-analysis

Abstract

Introduction: Minor ischemic stroke, though often less disabling, carries a substantial risk of early recurrence. Intravenous thrombolysis remains the standard for acute management, yet optimal secondary prevention strategies post-IVT remain debated. Dual antiplatelet therapy (DAPT) has shown promise in high-risk patients. Our study evaluates the safety and efficacy of DAPT post-IVT by analyzing stroke recurrence, symptomatic intracranial hemorrhage, early neurological deterioration and 90-day mortality outcomes. Methodology: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar and Science-Direct, were extensively searched using a comprehensive search term to identify and retrieve available articles. The articles that included the assessment of the efficacy of DAPT post intravenous thrombolysis for Ischemic stroke were considered for the final analysis. The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The pooled proportion of occurrence SICH and Recurrent ischemic stroke was assessed as the primary outcome. The secondary outcomes included occurence of Mortality and Early Neurological deficits. The Mantel-Haenszel method (Common effect model) and the Inverse variance method (Random effects model) were utilized to analyse the odds ratio. The I^2 test was used to assess the heterogeneity. Results: This study included a total of 10 articles consisting of 5049 patients who received DAPT therapy post post intravenous thrombolysis for Ischemic stroke. The pooled proportion of recurrence of ischemic stroke- 0.03( 95% CI [0.01;0.08], I^2= 82.9%, p<0.0001); occurrence of SICH - 0.03 (95% CI [0.02;0.06], I^2 = 61.9%, p = 0.0223), occurrence of Mortality 0.03 (95% CI [0.01;0.08], I^2 = 96.2%, p< 0.0001) and occurrence of early neurological deficits 0.16 (95% CI [0.06; 0.36], I^2 = 96.3% , p < 0.0001). Conclusion: This study suggest that DAPT therapy post intravenous thrombolysis for ischemic stroke reduces the risk of recurrence of ischemic stroke, occurrence of SICH, Mortality and Early Neurological Deficits.