Dual antiplatelet therapy versus intravenous tissue plasminogen activator with acute minor ischemic stroke: A systematic review and meta-analysis of safety and efficacy

Objectives To compare the safety and efficacy of Dual Antiplatelet Therapy (DAPT) and Intravenous (IV) Tissue Plasminogen Activator (t-PA) in Acute minor Ischemic Stroke (AIS). Materials and Methods Following Cochrane and PRISMA guidelines, we analyzed observational studies and clinical trials comparing DAPT and IV t-PA in patients with minor AIS. Databases included PubMed, Scopus, and Web of Science. Data extraction included study characteristics, patient demographics, and analyzed outcomes. RevMan 5.3 and OpenMetaAnalyst 2021 were used to analyze the data and assess heterogeneity, respectively. The risk of bias was determined using RoB 2.0 and the Newcastle-Ottawa scale. Results This meta-analysis included five studies with 3,978 DAPT-treated patients and 2,224 t-PA-treated patients. We found no significant differences in achieving mRS scores of 0-1 (OR 1.11, 95% CI: 0.79, 1.55, p = 0.56) and 0-2 (OR 0.90, 95% CI: 0.61, 1.31, p = 0.57), as well as combined mRS scores (OR 1.05, 95% CI: 0.82, 1.34, p = 0.72). Similarly, there were no significant disparities between the two treatment groups in NIHSS score changes from baseline (MD 0.32, 95% CI: -0.35, 0.98, p = 0.35) and in mortality rates (OR 0.87, 95% CI: 0.26, 2.93, p = 0.83). Notably, in comparison to the IV t-PA group, the DAPT group exhibited a significantly lower incidence of bleeding (OR 0.31, 95% CI: 0.14, 0.69, p = 0.004) and symptomatic intracranial hemorrhage (sICH) (OR 0.10, 95% CI: 0.04, 0.26, p < 0.00001). Conclusions Our meta-analysis found no significant differences in efficacy between DAPT and IV t-PA. However, DAPT demonstrated a significantly lower risk of sICH and bleeding compared with IV t-PA.