Aspirin Should Be First-Line Antiplatelet Therapy in the Secondary Prevention of Stroke

Long-term management after an ischemic stroke (or tran-sient ischemic attack [TIA]) boils down to reducing notjust the high risk of a stroke but also the risk of other serious events due to similar underlying vascular pathology, such as myocardial infarction (MI) and sudden cardiac death.1 Therefore, minimizing causal vascular risk factors (blood pres-sure, cholesterol, smoking, and diabetes) and lifestyle modifica-tion (diet, exercise) are crucial, along with carotid endarterecto-my for a few carefully selected patients. But what about doing something about the blood, such as antithrombotic therapy? Aspirin Works! A vast amount of randomized data supports the use of antiplate-let drugs to prevent serious vascular events (stroke, MI, and vascular death) in a wide range of patients at high vascular risk (eg, stroke survivors, MI survivors, claudicants). This has been summarized recently by the Antithrombotic Trialists ’ collabora-tion.2 The bottom line is that antiplatelet drugs reduce the odds