Del Giovane C, Boncoraglio GB, Bertù L, et al. - Considering the benefits and harms ratio, following antiplatelet drugs appeared as the best choices for secondary prevention of patients with ischemic stroke or TIA: cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day.

• From MEDLINE, EMBASE and CENTRAL, 57 RCTs were reviewed; data for the meta-analyses were retrieved from 50 (n = 165,533 participants).

• Cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day result in significant reduction in the risk of all strokes when compared with placebo/no treatment.

• In addition, aspirin > 150 mg/day and the combinations clopidogrel/aspirin, ticagrelor/aspirin, reduced all strokes but raised the risk of hemorrhagic events.

• Significantly reduced all-cause mortality was observed only with aspirin > 150 mg/day.

• Clopidogrel significantly lowered the risk of all strokes, cardiovascular events, and intracranial hemorrhage outcomes when compared with aspirin ≤ 150 mg/day.

• Advantages also appeared in correlation with cilostazol, however, data are limited to the Asian population.