What does this research mean for the field?

Antithrombotic therapy selection for secondary stroke prevention should be tailored to the underlying pathophysiological mechanism, using antiplatelet therapy for atherosclerosis and anticoagulant agents for cardiogenic embolism. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To review clinical trial evidence and guidelines for antithrombotic therapy in secondary stroke prevention based on ischemic stroke etiology.

September 9, 2026Journal of the American College of CardiologyOpen Access

Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease

Q: What is the clinical evidence from this study?

Study design: Review. Population: Ischemic Cerebrovascular Disease. Intervention: Antithrombotic therapy (antiplatelets and anticoagulants).

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Key result

Antiplatelets prevent recurrent stroke in atherosclerosis, while anticoagulants remain preferred for cardiogenic embolism.

Why the study?

Stroke survivors carry a high risk of recurrence, making antithrombotic selection based on underlying physiopathological mechanisms essential to reduce stroke burden.

Does antithrombotic therapy prevent recurrent strokes in stroke survivors?

Key Points

To review clinical trial evidence and guidelines for antithrombotic therapy in secondary stroke prevention based on ischemic stroke etiology.
Reviewed landmark randomized controlled trials, systematic reviews, and meta-analyses investigating antiplatelet and anticoagulant regimens for secondary stroke prevention.
Assessed antithrombotic efficacy across stroke subtypes, including noncardioembolic disease (large-artery atherosclerosis, small vessel disease) and cardioembolic conditions (atrial fibrillation).
In acute minor stroke or high-risk TIA, the CHANCE trial demonstrated that dual antiplatelet therapy (DAPT) with clopidogrel and aspirin reduced recurrent stroke to 8.2% versus 11.7% with aspirin alone (ARR = 3.5%; NNT = 29).
In trials enrolling over 40,000 patients, aspirin initiated within 48 hours of stroke produced a 1.3% absolute risk reduction in death and disability at 6 months compared with placebo (NNT = 77).

Structured PICO

Does antithrombotic therapy prevent recurrent strokes in stroke survivors?

Population

Review of antithrombotic therapies for secondary prevention of recurrent strokes in patients with ischemic cerebrovascular disease.

Intervention

Antithrombotic therapy (antiplatelet agents and anticoagulant agents)

Outcome

Recurrent stroke prevention

This review provides a comprehensive guide to selecting antithrombotic therapy for secondary stroke prevention based on the underlying stroke etiology.

Implication

Supports etiology-guided antithrombotic selection in secondary prevention; confirms RCT consensus while leaving optimal regimens open for further trials.

Abstract

Stroke survivors carry a high risk of recurrence. Antithrombotic medications are paramount for secondary prevention and thus crucial to reduce the overall stroke burden. Appropriate antithrombotic agent selection should be based on the best understanding of the physiopathological mechanism that led to the initial ischemic injury. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis and endothelial injury, whereas anticoagulant agents are favored for cardiogenic embolism and highly thrombophilic conditions. Large randomized controlled trials have provided new data to support recommendations for the evidence-based use of antiplatelet agents and anticoagulant agents after stroke. In this review, the authors cover recent trials that have altered clinical practice, cite systematic reviews and meta-analyses, review evidence-based recommendations based on older landmark trials, and indicate where there are still evidence-gaps and new trials being conducted.

Discussion

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Cite This Study

Brutto et al. (2019) conducted a review in Ischemic Cerebrovascular Disease. Antithrombotic therapy (antiplatelets and anticoagulants) was evaluated. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis, whereas anticoagulant agents are favored for cardiogenic embolism to prevent recurrent strokes.

synapsesocial.com/papers/6aa124741caef1e9822ead65 https://doi.org/10.1016/j.jacc.2019.06.039

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Implication

Supports etiology-guided antithrombotic selection in secondary prevention; confirms RCT consensus while leaving optimal regimens open for further trials.

Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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