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European Heart Journal Advance Access originally published online on March 17, 2008
European Heart Journal 2008 29(9):1086-1092; doi:10.1093/eurheartj/ehn106
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Network meta-analysis: simultaneous meta-analysis of common antiplatelet regimens after transient ischaemic attack or stroke

Vincent Thijs1,*, Robin Lemmens1 and Steffen Fieuws2

1 Department of Neurology, University Hospitals Leuven and Department for Transgene Technology and Gene Therapy, VIB Herestraat 49, 3000 Leuven, Belgium
2 Biostatistical Centre, Department of Public Health, Catholic University Leuven, Leuven, Belgium

Received 23 November 2007; revised 11 January 2008; accepted 14 February 2008; online publish-ahead-of-print 18 March 2008.

* Corresponding author. Tel: +32 163 44280, Fax: +32 163 44285, Email: vincent.thijs{at}uz.kuleuven.ac.be

See page 1082 for the editorial comment on this article (doi:10.1093/eurheartj/ehn109)

Network meta-analysis can provide estimates of treatment efficacy of multiple treatment regimens, even when direct comparisons are unavailable. We used network meta-analysis to compare commonly used antiplatelet regimens in the prevention of serious vascular events after transient ischaemic attack (TIA) or stroke. We performed direct meta-analyses of randomized, controlled trials evawluating antiplatelet agents after TIA or stroke. We chose the endpoint stroke, myocardial infarction, and vascular death. Network meta-analysis was then used to estimate the relative efficacy of the various antiplatelet regimens. Twenty-four trials involving 42688 TIA or stroke patients who suffered 6830 serious vascular events were included. In the network meta-analysis, all antiplatelet regimens (aspirin, aspirin plus dipyridamole, thienopyridines, and combination of aspirin and thienopyridines) were significantly more effective than placebo. The combination of aspirin and dipyridamole was more effective than thienopyridines (OR, 0.84; 95% CI, 0.73–0.97) and more effective than aspirin (OR, 0.78; 95% CI, 0.70–0.87). Our analysis suggests that the most powerful antiplatelet regimen in the prevention of serious vascular events after TIA or stroke is the combination of aspirin and dipyridamole. Network meta-analysis could be used to synthesize accumulating evidence from clinical trials in a broad range of vascular disorders.

Key Words: Meta-analysis • Cerebrovascular disorders • Antiplatelet agents

This paper was guest edited by Dr Heinrich P. Mattle, University Bern, Inselspital Bern, Neurologische Universitatsklinik, Bern, Switzerland


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