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Flow diagram.
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Figure 1

Flow diagram.

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Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.1 Death or dependence at end of follow‐up.
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Figure 2

Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.1 Death or dependence at end of follow‐up.

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Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.2 Deaths from all causes during treatment period.
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Figure 3

Funnel plot of comparison: 1 Antiplatelet agent versus control in acute presumed ischaemic stroke, outcome: 1.2 Deaths from all causes during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 1 Death or dependence at end of follow‐up.
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Analysis 1.1

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 1 Death or dependence at end of follow‐up.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 2 Deaths from all causes during treatment period.
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Analysis 1.2

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 2 Deaths from all causes during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 3 Deaths from all causes during follow‐up.
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Analysis 1.3

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 3 Deaths from all causes during follow‐up.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 4 Deep venous thrombosis during treatment period.
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Analysis 1.4

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 4 Deep venous thrombosis during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 5 Pulmonary embolism during treatment period.
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Analysis 1.5

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 5 Pulmonary embolism during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 6 Recurrent ischaemic/unknown stroke during treatment period.
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Analysis 1.6

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 6 Recurrent ischaemic/unknown stroke during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 7 Symptomatic intracranial haemorrhage during treatment period.
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Analysis 1.7

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 7 Symptomatic intracranial haemorrhage during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 8 Any recurrent stroke/intracranial haemorrhage during treatment period.
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Analysis 1.8

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 8 Any recurrent stroke/intracranial haemorrhage during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 9 Major extracranial haemorrhage during treatment period.
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Analysis 1.9

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 9 Major extracranial haemorrhage during treatment period.

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Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 10 Complete recovery from stroke (post hoc).
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Analysis 1.10

Comparison 1 Antiplatelet drug versus control in acute presumed ischaemic stroke, Outcome 10 Complete recovery from stroke (post hoc).

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Table 1. Absolute risk reductions of aspirin treatment in acute stroke

Outcome

Control event rate

No of events avoided

NNTB or NNTH

Per 1000 people treated (95% CI)

Data are number needed to treat to benefit (NNTB) (95% CI) unless otherwise indicated. NNTH = number needed to treat to harm

Estimated from the average of the control event rate in the 2 largest trials (CAST 1997 and IST 1997)

Estimated by applying the odds ratio for the outcome for studies of aspirin. Calculator is available at: http://www.dcn.ed.ac.uk/csrg/entity/entity_NNT2.asp

Estimated by applying the odds ratio for the outcome for studies of aspirin. Calculator is available at: http://www.dcn.ed.ac.uk/csrg/entity/entity_NNT2.asp

Death or dependence at end of follow‐up

0.47

13 (3 to 23)

79 (43 to 400)

Deaths from all causes during follow‐up

0.13

9 (2 to 15)

108 (66 to 436)

Pulmonary embolism during treatment period

0.01

1 (0 to 2)

693 (427 to 6700)

Recurrent ischaemic/unknown stroke during treatment period

0.03

7 (4 to 10)

140 (104 to 248)

Symptomatic intracranial haemorrhage during treatment period

0.01

‐2 (i.e. 2 extra) (‐4 to 0)

NNTH 574 (254 to 126 010)

Any recurrent stroke/intracranial haemorrhage during treatment

0.04

5 (1 to 8)

200 (123 to 868)

Major extracranial haemorrhage during treatment period

0.01

‐4 (i.e. 4 extra) (‐7 to ‐2)

NNTH 245 (153 to 481)

Complete recovery from stroke (post hoc)

0.26

11 (2 to 21)

89 (49 to 523)
Figuras y tablas -
Table 1. Absolute risk reductions of aspirin treatment in acute stroke
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Comparison 1. Antiplatelet drug versus control in acute presumed ischaemic stroke

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependence at end of follow‐up Show forest plot

4

41291

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.95 [0.91, 0.99]

1.1 Aspirin versus control

4

41291

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.95 [0.91, 0.99]

2 Deaths from all causes during treatment period Show forest plot

8

41483

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.92 [0.85, 1.00]

2.1 Aspirin versus control

4

41291

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.92 [0.85, 1.00]

2.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.47 [0.43, 4.99]

2.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.12 [0.01, 1.20]

3 Deaths from all causes during follow‐up Show forest plot

8

41483

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.92 [0.87, 0.98]

3.1 Aspirin versus control

4

41291

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.92 [0.87, 0.98]

3.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.47 [0.43, 4.99]

3.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.12 [0.02, 0.88]

4 Deep venous thrombosis during treatment period Show forest plot

2

133

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.78 [0.36, 1.67]

4.1 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.35 [0.13, 0.95]

4.2 Ticlopidine versus control

1

53

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.37 [0.72, 7.73]

5 Pulmonary embolism during treatment period Show forest plot

7

41042

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.71 [0.53, 0.96]

5.1 Aspirin versus control

3

40850

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.71 [0.53, 0.97]

5.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.39 [0.15, 372.38]

5.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.13 [0.01, 2.06]

6 Recurrent ischaemic/unknown stroke during treatment period Show forest plot

7

41042

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.77 [0.69, 0.87]

6.1 Aspirin versus control

3

40850

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.77 [0.69, 0.87]

6.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Symptomatic intracranial haemorrhage during treatment period Show forest plot

7

41042

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.23 [1.00, 1.50]

7.1 Aspirin versus control

3

40850

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.22 [1.00, 1.50]

7.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.0 [0.14, 7.38]

7.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.70 [0.36, 20.26]

8 Any recurrent stroke/intracranial haemorrhage during treatment period Show forest plot

7

41042

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.88 [0.79, 0.97]

8.1 Aspirin versus control

3

40850

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.87 [0.79, 0.97]

8.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.0 [0.14, 7.38]

8.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.70 [0.36, 20.26]

9 Major extracranial haemorrhage during treatment period Show forest plot

7

41042

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.69 [1.35, 2.11]

9.1 Aspirin versus control

3

40850

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.69 [1.35, 2.11]

9.2 Aspirin plus dipyridamole versus control

1

80

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Ticlopidine versus control

3

112

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Complete recovery from stroke (post hoc) Show forest plot

2

40541

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.06 [1.01, 1.11]

10.1 Aspirin versus control

2

40541

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.06 [1.01, 1.11]
Figuras y tablas -
Comparison 1. Antiplatelet drug versus control in acute presumed ischaemic stroke
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