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Within this network meta-analysis we aimed to summarize the current evidence for using antiplatelet drugs for secondary stroke prevention.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We searched MEDLINE, EMBASE and CENTRAL up to September 2020. Randomized controlled trials (RCTs) assessing antiplatelet drugs for secondary stroke prevention were included. We did pairwise meta-analyses and network meta-analyses using random-effects models. Primary outcomes were all strokes (ischemic or hemorrhagic) and all-cause mortality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The review included 57 RCTs, 50 (<jats:italic>n<\/jats:italic>\u2009=\u2009165,533 participants) provided data for the meta-analyses. Compared to placebo\/no treatment, moderate to high-confidence evidence indicated that cilostazol, clopidogrel, dipyridamole\u2009+\u2009aspirin, ticagrelor, ticlopidine, and aspirin\u2009\u2264\u2009150\u2009mg\/day significantly reduced the risk of all strokes (odds ratios, ORs and absolute risk difference, ARD): cilostazol 0.51 (95\u2009% confidence interval, CI, 0.37 to 0.71; 3.6\u2009% fewer), clopidogrel 0.63 (95\u2009% CI, 0.49 to 0.79; 2.7\u2009% fewer), dipyridamole\u2009+\u2009aspirin 0.65 (95\u2009% CI, 0.55 to 0.78; 2.5\u2009% fewer), ticagrelor 0.68 (95\u2009% CI, 0.50 to 0.93; 2.3\u2009% fewer), ticlopidine 0.74 (95\ufeff %\u00a0CI 0.59 to 0.93; 1.9\u2009% fewer), aspirin\u2009\u2264\u2009150\u2009mg\/day\u00a00.79 (95\u00a0%\u00a0CI, 0.66 to 0.95; 1.5\u2009% fewer). Aspirin\u2009&gt;\u2009150\u2009mg\/day and the combinations clopidogrel\/aspirin, ticagrelor\/aspirin, also decrease all strokes but increase the risk of hemorrhagic events. Only aspirin\u2009&gt;\u2009150\u2009mg\/day significantly reduced all-cause mortality (OR 0.86, 95\u00a0%\u00a0CI 0.76 to 0.97; ARD 0.9\u2009%, 95\u00a0%CI 1.5\u20130.2\u2009% fewer, moderate confidence). Compared to aspirin\u2009\u2264\u2009150\u2009mg\/day, clopidogrel significantly reduced the risk of all strokes, cardiovascular events, and intracranial hemorrhage outcomes. Cilostazol also appeared to provide advantages but data are limited to the Asian population.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Considering the benefits and harms ratio, cilostazol, clopidogrel, dipyridamole\u2009+\u2009aspirin, ticagrelor, ticlopidine, and aspirin\u2009\u2264\u2009150\u2009mg\/day appear to be the best choices as antiplatelet drugs for secondary prevention of patients with ischemic stroke or TIA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Systematic review registration<\/jats:title>\n                <jats:p>PROSPERO <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42020159896\">CRD42020159896<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02341-2","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T07:04:13Z","timestamp":1629097453000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis"],"prefix":"10.1186","volume":"21","author":[{"given":"Cinzia","family":"Del Giovane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio B.","family":"Boncoraglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Bert\u00f9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Banzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5550-3412","authenticated-orcid":false,"given":"Irene","family":"Tramacere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"issue":"8","key":"2341_CR1","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1161\/STROKEAHA.120.029606","volume":"51","author":"HA Wafa","year":"2020","unstructured":"Wafa HA, Wolfe CDA, Emmett E, Roth GA, Johnson CO, Wang Y. 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