Antithrombotic Therapy in Secondary Stroke Prevention

Ischemic stroke is a major cause of morbidity and mortality. The choice of antithrombotic therapy is largely dependent on the type of stroke. In this article, the authors focus on the secondary prevention of stroke, providing evidence from the literature. The mechanism of action of each of the antithrombotic drugs is discussed. Anticoagulation with warfarin for cardioembolic stroke, particularly atrial fibrillation, is strongly recommended, while no clear advantage for warfarin over aspirin exists for ischemic stroke secondary to atherothrombotic or patent foramen ovale. Combination therapies of aspirin plus warfarin do not offer any additional therapeutic benefit and carry an increased risk of hemorrhage. Aspirin and clopidogrel present similar risks for stroke recurrence. The combination of aspirin with extended-release dipyridamole has a lower risk of stroke than aspirin alone and does not enhance the risk of hemorrhage. Finally, some recommendations and future perspectives are included.