{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:19:23Z","timestamp":1788254363911,"version":"build-2803163510"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"abstract":"<jats:sec>\n                    <jats:title>Background and aim:<\/jats:title>\n                    <jats:p>Individuals without stenotic large-artery atherosclerosis (LAA) are an important subgroup of the patients who suffer transient ischemic attack (TIA) or ischemic stroke (IS), and they are commonly treated with dual antiplatelet therapy (DAPT). Stenotic LAA is a marker of higher vascular risk, and current guideline-defining trials did not prospectively evaluate if negative LAA status modifies the effect of DAPT. Moreover, platelet activation may not contribute as much toward future stroke risk after excluding stenotic LAA, leaving uncertainty regarding the applicability of this treatment among populations without this marker. We aimed to evaluate the efficacy and safety of DAPT compared with monotherapy for patients who suffered a TIA or IS without stenosis of 50% or more on vessel imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to November 2025 for publications in English. We included randomized controlled trials comparing short-term (up to 90\u2009days) DAPT to single antiplatelet therapy after a TIA or IS with outcome data available for the groups without 50% or more stenosis on vessel imaging. Data were pooled using random-effects for non-rare outcomes and Bayesian models for rare outcomes. The primary outcome was a new ischemic or hemorrhagic stroke. We also analyzed ischemic and hemorrhagic stroke individually, moderate and severe bleeding, any bleeding, all-cause death, functionality and a composite vascular outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eight publications met the eligibility criteria. DAPT was associated with a reduction in new stroke, with a relative risk of 0.80 (95% CI 0.65 to 0.98; p\u2009=\u20090.04, I\u00b2\u2009=\u200925.5%). Trial sequential analysis showed a substantial risk of type I error, and a sensitivity analysis restricted to studies that included only high-risk TIA or mild IS found no significant benefit. There was an increase in moderate and severe bleeding (odds ratio of 2.70, 95% Bayesian Credible Interval 1.28 to 4.85) and no differences in functionality and mortality. Heterogeneity in trial methodology and populations may limit interpretation of our findings, but sensitivity analyses evaluating the impacts of DAPT duration and region of trial conduction on new stroke did not show significant effects, although they are hindered by the small number of studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In patients with TIA or IS with a negative assessment of stenotic atherosclerosis on any vessel imaging, the benefit of DAPT is unclear, particularly for individuals with high-risk TIA and mild IS, while there is an increased risk of bleeding. Further trials are required to clarify if DAPT is truly beneficial for these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930261475466","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T12:20:45Z","timestamp":1784982045000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dual antiplatelet therapy in stroke without stenotic atherosclerosis: A meta-analysis with trial sequential analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6372-4253","authenticated-orcid":false,"given":"Mateus K","family":"Ibiapino","sequence":"first","affiliation":[{"name":"Faculdade Municipal Professor Franco Montoro, Mogi Gua\u00e7u, Brazil"},{"name":"Hospital Vera Cruz, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3987-4340","authenticated-orcid":false,"given":"Marwa","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Elrazi University, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9766-210X","authenticated-orcid":false,"given":"Vanisha","family":"Kumar","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, Guwahati, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7147-1208","authenticated-orcid":false,"given":"Diana L","family":"Mamani-Sucari","sequence":"additional","affiliation":[{"name":"Universidad Cat\u00f3lica de Santa Mar\u00eda (UCSM), Arequipa, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3016-7265","authenticated-orcid":false,"given":"Sofia ZS","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina de Jundia\u00ed, Jundia\u00ed, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3477-9095","authenticated-orcid":false,"given":"Igor","family":"Haitovich","sequence":"additional","affiliation":[{"name":"Ben-Gurion University of the Negev, Be\u2019er Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4406-9717","authenticated-orcid":false,"given":"Leonardo C","family":"Borgomanero","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio de Mineiros (UNIFIMES), Mineiros, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3247-3123","authenticated-orcid":false,"given":"Gisele S","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000513"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1516402"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000377"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-13210-0"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.072"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.07.025"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.035675"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.923142"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032239"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873251323180"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.575670"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2009.05.006"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-17619-y"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.125.078763"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215340"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800410"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033040"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2025.02.017"},{"key":"e_1_3_2_20_2","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current (accessed 15 December 2025)."},{"key":"e_1_3_2_21_2","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.","journal-title":"BMJ"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"e_1_3_2_23_2","unstructured":"Bain P. Research guides: systematic reviews and meta analysis randomized controlled trials https:\/\/guides.library.harvard.edu\/c.php?g=309982&p=2079544 (accessed 15 December 2025)."},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.009449"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017866"},{"key":"e_1_3_2_27_2","unstructured":"Chapter 10: analysing data undertaking meta-analyses Cochrane https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current\/chapter-10#section-10-4-4 (accessed 15 December 2025)."},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1370"},{"key":"e_1_3_2_29_2","unstructured":"Guenhan BK Roever C. University (src\/init.cpp T of C et al. MetaStan: Bayesian Meta-Analysis via \u201cStan.\u201d https:\/\/cran.r-project.org\/web\/packages\/MetaStan\/index.html (2022 accessed 15 December 2025)"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/eb-2018-102911"},{"key":"e_1_3_2_31_2","unstructured":"The Copenhagen Trial Unit. Trial sequential analysis https:\/\/ctu.dk\/tools"},{"key":"e_1_3_2_32_2","article-title":"Ninety-day stroke recurrence in minor stroke: systematic review and meta-analysis of trials and observational studies","volume":"13","author":"Lim A","year":"2024","unstructured":"Lim A, Ma H, Johnston SC, et al. Ninety-day stroke recurrence in minor stroke: systematic review and meta-analysis of trials and observational studies. J Am Heart Assoc Cardiovasc Cerebrovasc Dis 2024; 13: e032471.","journal-title":"J Am Heart Assoc Cardiovasc Cerebrovasc Dis"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031329"},{"key":"e_1_3_2_34_2","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.","journal-title":"BMJ"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.333.7568.597"},{"key":"e_1_3_2_36_2","unstructured":"Streamline evidence-based guidelines with GRADEpro https:\/\/www.gradepro.org\/ (accessed 23 January 2026)."},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036318"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.78049"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001972"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105115"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2015.11.1.57"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.0932"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.034089"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033033"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2021-001166"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2293"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12630"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.3344"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.041442"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11979-6"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00403-9"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709118"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106857"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-025-11451-1"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0000000000000662"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000523"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-025-02664-5"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261475466","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17474930261475466","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261475466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:55:39Z","timestamp":1788252939000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17474930261475466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":57,"alternative-id":["10.1177\/17474930261475466"],"URL":"https:\/\/doi.org\/10.1177\/17474930261475466","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]},"article-number":"17474930261475466"}}