Comparison of DAPT and Thrombolysis in Minor Stroke with Regard to Efficacy: A Meta-Analysis

Abstract

Objective: Minor ischemic stroke (NIHSS ≤ 5) presents a therapeutic dilemma, balancing the potential benefits of intravenous thrombolysis (IVT) against its hemorrhagic risks, with dual antiplatelet therapy (DAPT) established for recurrence prevention. This meta-analysis compares the efficacy and safety of dual antiplatelet therapy (DAPT) versus intravenous thrombolysis (IVT) in patients with minor stroke, examining functional recovery, the risk of symptomatic intracranial haemorrhage (SICH) and mortality.

Methods: A systematic search of databases was done in PubMed, Embase, Scopus, and Cochrane until June 2025. The studies comparing DAPT and IVT were conducted in patients with minor stroke. Risk ratios (RR) at 95% confidence interval (CI) were pooled with a random-effects model. Heterogeneity was assessed using I2 statistics, and analyses were conducted using RevMan 5.4.

Results: There was no substantial difference between DAPT and IVT in functional recovery i.e., mRS 0-1 (RR, 1.03; 95% CI 0.98-1.09; p = 0.24), mRS 0-2 (RR 1.00; 95% CI 0.98-1.03; p = 0.87). The risk of SICH was significantly lower when using DAPT (RR 0.10; 95% CI 0.03-0.29; p < 0.0001). There was a reduction in mortality that was not statistically significant with DAPT. The stability of results was established by sensitivity analysis.

Conclusions: In minor ischemic stroke, DAPT provides similar functional recovery to IVT while offering a significantly improved safety profile through reduced SICH risk. DAPT may represent a safer alternative to thrombolysis in this patient population.

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BibTeX RIS

BibTeX

@article{shoaib2026comparison,
  title = {{Comparison of DAPT and Thrombolysis in Minor Stroke with Regard to Efficacy: A Meta-Analysis}},
  author = {MUHAMMAD SHOAIB and HASEEB AHMED and AREEB JEHANGIR CHAUDHARY and ABIN ROY and WAFAA DRAO and RIDA-E ZAHRA and ZORAIZ HAIDER and MUHAMMAD SHAMS UL HAQ and ALIZAY FATIMA and SYED HAIDER FAROOQ SHERAZI and AHMED INTAKHAB},
  journal = {Juntendo Medical Journal},
  year = {2026},
  month = jun,
  url = {https://europepmc.org/article/MED/42973804},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Comparison of DAPT and Thrombolysis in Minor Stroke with Regard to Efficacy: A Meta-Analysis
AU  - MUHAMMAD SHOAIB
AU  - HASEEB AHMED
AU  - AREEB JEHANGIR CHAUDHARY
AU  - ABIN ROY
AU  - WAFAA DRAO
AU  - RIDA-E ZAHRA
AU  - ZORAIZ HAIDER
AU  - MUHAMMAD SHAMS UL HAQ
AU  - ALIZAY FATIMA
AU  - SYED HAIDER FAROOQ SHERAZI
AU  - AHMED INTAKHAB
PY  - 2026
DA  - 2026/06/05
JO  - Juntendo Medical Journal
UR  - https://europepmc.org/article/MED/42973804
AB  - Objective: Minor ischemic stroke (NIHSS ≤ 5) presents a therapeutic dilemma, balancing the potential benefits of intravenous thrombolysis (IVT) against its hemorrhagic risks, with dual antiplatelet therapy (DAPT) established for recurrence prevention. This meta-analysis compares the efficacy and safety of dual antiplatelet therapy (DAPT) versus intravenous thrombolysis (IVT) in patients with minor stroke, examining functional recovery, the risk of symptomatic intracranial haemorrhage (SICH) and mortality.  Methods: A systematic search of databases was done in PubMed, Embase, Scopus, and Cochrane until June 2025. The studies comparing DAPT and IVT were conducted in patients with minor stroke. Risk ratios (RR) at 95% confidence interval (CI) were pooled with a random-effects model. Heterogeneity was assessed using I2 statistics, and analyses were conducted using RevMan 5.4.  Results: There was no substantial difference between DAPT and IVT in functional recovery i.e., mRS 0-1 (RR, 1.03; 95% CI 0.98-1.09; p = 0.24), mRS 0-2 (RR 1.00; 95% CI 0.98-1.03; p = 0.87). The risk of SICH was significantly lower when using DAPT (RR 0.10; 95% CI 0.03-0.29; p < 0.0001). There was a reduction in mortality that was not statistically significant with DAPT. The stability of results was established by sensitivity analysis.  Conclusions: In minor ischemic stroke, DAPT provides similar functional recovery to IVT while offering a significantly improved safety profile through reduced SICH risk. DAPT may represent a safer alternative to thrombolysis in this patient population.
SN  - 2759-7504
ER  -

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