Antithrombotic Therapy for Secondary Stroke Prevention

For secondary prevention of ischemic stroke, making an appropriate diagnosis of stroke subtype based on its mechanism and applying the appropriate medical management are the most important factors. In particular, antithrombotic therapy plays a crucial role among them. In selecting the best management strategies for an individual patient with a given condition, we should consider the impact of antithrombotic therapy not only on outcome, but also the risk benefit ratio. To satisfy these conditions, the appropriate timing and dosage of the antithrombotic agents are important. For acute stroke patients, more aggressive treatment, such as dual antiplatelet therapy following loading dose administration, is recommended. However, in the chronic period, discontinuation of dual therapy is recommended in the same Japanese guidelines. Although the optimal timing to start anticoagulant therapy after stroke is still not completely clear, we hope that detailed guidelines like those used in the field of coronary interventions are established soon.