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European Heart Journal Advance Access originally published online on September 17, 2008
European Heart Journal 2008 29(20):2580; doi:10.1093/eurheartj/ehn397
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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

Is the finding of the PROFESS study consistent with predictions of network meta-analysis?

Simon K.H. Lam

Institute of Cardiovascular Science and Medicine
University of Hong Kong
11th Floor, 5-9 Hankow Road, TST
Hong Kong
People's Republic of China
Tel: +852 6898 2200
Fax: +852 6898 2218
Email: simon.lam{at}medsci.oxon.org

Andrew Owen

Department of Cardiology
Canterbury Hospital
Canterbury
Kent CT1 3NG
UK

The network meta-analysis performed by Thijs et al.1 found that the use of the combination of aspirin and dipyridamole (ASA + D) is better than thienopyridines or aspirin alone in secondary prevention of vascular events after transient ischaemic attack or stroke. The accompanying editorial2 suggested that the PROFESS study could be used to assess the validity of these findings. The PROFESS study results are now available3 and suggest that ASA + D has a similar efficacy to clopidegrel, which was not predicted by the meta-analysis.

A potential weakness of the generalized linear model adopted by Thijs et al. is the assumption of a constant random effect for all treatment comparisons from the same trial, which may be relevant to the findings. This approach is not ideal when there are a large number of multigroup trials.4 Using the summary data provided by Thijs et al., we address this potential limitation using Bayesian network meta-analysis with appropriate modelling of random effects for multigrouped trials.5 We found that ASA + D was superior to aspirin alone (as did Thijs et al.) but that there was no statistically significant difference between ASA + D and thienopyridines (Table 1) concordant with the findings from PROFESS.


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  		Table 1 Result of Bayesian network meta-analysis of 24 trials with 6830 events from 42 688 patients

 

References

  1. Thijs V, Lemmens R, Fieuws S. Network meta- analysis: simultaneous meta-analysis of common antiplatelet regimens after transient ischaemic attack or stroke. Eur Heart J (2008) 29:1086–1092.[Abstract/Free Full Text]
  2. Baumgartner RW. Network meta-analysis of antiplatelet treatments for secondary stroke prevention. Eur Heart J (2008) 29:1082–1083.[Free Full Text]
  3. Diener HC, Yusuf S, Sacco R, for the PROFESS Investigators. Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) trial: cognitive and functional outcomes after stroke. European Stroke Conference 2008, 14 May 2008. Nice, France.
  4. Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med (2002) 21:2313–2324.[CrossRef][Web of Science][Medline]
  5. Higgins JP, Whitehead A. Borrowing strength from external trials in a meta-analysis. Stat Med (1996) 15:2733–2749.[CrossRef][Web of Science][Medline]

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This Article
Right arrow FREE Full Text (PDF) Freely available
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29/20/2580    most recent
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