Antiplatelet therapy for secondary prevention of stroke
- Brett L Cucchiara, MD
Brett L Cucchiara, MD
- Associate Professor of Neurology
- University of Pennsylvania Medical Center
- Steven R Messé, MD
Steven R Messé, MD
- Associate Professor of Neurology
- Hospital of the University of Pennsylvania
Antiplatelet therapy is used for both the management of acute ischemic stroke and for the prevention of stroke. Antiplatelet therapy reduces the incidence of stroke in patients at high risk for atherosclerosis and in those with known symptomatic cerebrovascular disease.
Antiplatelet therapy for secondary stroke prevention will be reviewed here. Antiplatelet therapy for acute ischemic stroke and for primary stroke prevention is discussed separately. (See "Antithrombotic treatment of acute ischemic stroke and transient ischemic attack" and "Overview of primary prevention of coronary heart disease and stroke".)
Prevention of recurrent stroke with antithrombotic therapy in patients with atrial fibrillation is reviewed elsewhere. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization".)
Aspirin, the most commonly used antiplatelet agent, inhibits the enzyme cyclooxygenase, reducing production of thromboxane A2, a stimulator of platelet aggregation. This interferes with the formation of thrombi, thereby reducing the risk of stroke. (See "Aspirin for the secondary prevention of atherosclerotic cardiovascular disease".)
The effectiveness of aspirin for preventing ischemic stroke and cardiovascular events is supported by the following observations:
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- SPS3 Investigators, Benavente OR, Hart RG, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med 2012; 367:817.
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- Culebras A, Rotta-Escalante R, Vila J, et al. Triflusal vs aspirin for prevention of cerebral infarction: a randomized stroke study. Neurology 2004; 62:1073.
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- Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160.
- Dose of aspirin
- - Toxicity and risk of bleeding
- Side effects of clopidogrel
- Aspirin plus clopidogrel
- - Stroke subtypes
- Side effects of dipyridamole
- - Cardiac effects
- Aspirin plus dipyridamole
- Aspirin plus extended-release dipyridamole versus clopidogrel
- OTHER AGENTS
- - Side effects of ticlopidine
- CHOOSING THERAPY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS