Comparison of Antiplatelets and Anticoagulants for Secondary Stroke Prevention in Ischemic Stroke Patients with Cancer: A Meta-Analysis

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Abstract
This study aims to assess the efficacy and safety of antiplatelets (oral and subcutaneous) and anticoagulants for secondary stroke prevention in ischemic stroke patients with cancer, where the optimal antithrombotic strategy remains unclear. A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, and Scopus (inception to June 2024). Studies were screened based on predefined criteria and assessed with the Newcastle-Ottawa Scale. A random-effects model (R 4.1.2) was used to calculate odds ratios (OR) with 95% confidence intervals (CI). A total of four studies were included in the final analysis. The cumulative sample size was 2,781 participants: 2,204 (79.2%) were treated with antiplatelets and 577 (20.7%) were treated with anti-coagulants. The mean age (± SD) of the patients was 69.56 (±9.88) years, and 65.7% were men. There was no difference in the risk of recurrent ischemic stroke between antiplatelets and anticoagulants (OR = 0.74, 95% CI: 0.31–1.77, 3 studies with 700 patients). There were no differences in the risk of gastrointestinal hemorrhage (OR = 1.74, 95% CI: 0.17–17.46, 2 studies with 2,101 patients) and any major hemorrhage (OR = 0.70, 95% CI: 0.24–2.05, 4 studies with 2781 patients). The odds of all-cause mortality were lower in patients treated with antiplatelets (OR = 0.73, 95% CI: 0.59–0.90, 4 studies involving 2,781 patients). Antiplatelets and anticoagulants showed no difference in recurrent stroke or major hemorrhagic events, but antiplatelets were associated with lower mortality. However, due to limited data, these findings may not fully answer the clinical question, highlighting the need for further high-quality studies.

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