Key result
Acetylsalicylic acid is the primary choice for primary prevention, while acetylsalicylic acid combined with dipyridamole or clopidogrel alone are first-line therapies for secondary prevention of noncardioembolic ischemic stroke.
This review reinforces international guidelines recommending ASA for primary stroke prevention in specific populations, and ASA plus extended-release dipyridamole or clopidogrel monotherapy as first-line options for secondary prevention of noncardioembolic stroke.
Supports guideline-directed antiplatelet regimens for stroke prevention; reinforces consensus from existing evidence without new primary data.
BACKGROUND: Antiplatelet therapy plays a crucial role in the primary and secondary prevention of noncardioembolic ischemic stroke / transient ischemic attacks (IS/TIA). Several antiplatelet agents are available. This review deals with the characteristics of particular antiplatelet agents as well as choice of antiplatelet treatment in various situations, based on the evidence and international recommendations. METHODS: PubMed and Stroke Trials Registry on-line databases and the European Stroke Organisation Guidelines for Management of IS/TIA 2008 and update of the recommendations of the American Heart Association / American Stroke Association Council 2008 on Stroke were used. RESULTS: Acetylsalicylic acid (ASA) is the only antiplatelet drug used in primary prevention, mainly to reduce the risk of myocardial infarction (MI), but also in women aged 45 years or more and in some patients with non-valvular atrial fibrillation to reduce risk of IS/TIA. In the secondary prevention of noncardioembolic IS/TIA, ASA in combination with long release dipyridamole (DIP) and clopidogrel (CLOP) alone are considered first choice therapies. The choice of the particular antiplatelet agent should be individualized according to the patient risk factor profiles and treatment tolerance. ASA alone or triflusal can be used alternatively in patients who cannot be treated with either ASA+DIP or CLOP. The use of indobufen should be considered only in patients in need of temporary interruption of the antiplatelet therapy. Ticlopidine (TIC) should not be newly introduced into the treatment. Currently, insufficient data are available on the use of cilostazol in IS/TIA prevention.
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Král et al. (2010) conducted a review in Ischemic stroke and transient ischemic attack (IS/TIA). Oral antiplatelet therapy was evaluated. Acetylsalicylic acid is the primary choice for primary prevention, while acetylsalicylic acid combined with dipyridamole or clopidogrel alone are first-line therapies for secondary prevention of noncardioembolic ischemic stroke.
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