Shao QY, Wang ZJ, Ma XT, et al. - In coronary artery disease (CAD) patients already treated with antiplatelet therapy, a significant reduction of all stroke (mainly due to the reduction of ischemic stroke) resulted from either strengthening antiplatelet or anticoagulant treatments, although it elevated the risk of hemorrhagic stroke and intracranial hemorrhage.

• This is a meta-analysis of randomized controlled trials (n=42 studies with 301,547 participants) that documented data of stroke for patients with CAD and were randomized to receive intensive vs conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC).

• Use of intensive antithrombotic therapy conferred a significant decrease in the risk of all stroke (RR 0.86) and ischemic stroke (RR 0.80), but elevated risk of hemorrhagic stroke (RR 1.36) and intracranial hemorrhage (RR 1.46).

• OAC provided more benefit to all stroke compared with antiplatelet therapy (OAC: RR 0.73; Antiplatelet: RR 0.90).

• Advantage of antiplatelet therapy on all stroke as well as ischemic stroke were mainly driven by the studies comparing longer vs shorter duration of dual antiplatelet therapy (All stroke: RR 0.86; ischemic stroke: RR 0.84).