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Ischemic stroke prevention: an update on antiplatelet therapy
1University of Arkansas for Medical Sciences, College of Pharmacy Practice, Little Rock 72205-7199, USA.
Insights
Antiplatelet agents like aspirin and clopidogrel are crucial for preventing recurrent strokes. This review updates on their use and guidelines for patients with transient ischemic attack or noncardiogenic ischemic stroke.
Area of Science:
- Neurology
- Pharmacology
Background:
- Stroke is a leading cause of death and disability globally.
- Antiplatelet therapy is the primary treatment for preventing recurrent atherothrombotic strokes.
- Recent advancements in antiplatelet agents necessitate updated treatment guidelines.
Purpose of the Study:
- To review individual antiplatelet agents.
- To summarize current guidelines for antiplatelet selection and use in stroke patients.
- To provide an update on antiplatelet therapy for transient ischemic attack and noncardiogenic ischemic stroke.
Main Methods:
- Review of mechanisms of action for antiplatelet agents.
- Analysis of demonstrated efficacy of antiplatelet therapies.
- Evaluation of adverse effect profiles.
- Summary of current consensus recommendations for antiplatelet use.
Main Results:
- Aspirin, ticlopidine, clopidogrel, and aspirin/extended-release dipyridamole are discussed.
- Efficacy and safety profiles vary among agents.
- Guidelines have evolved with new drug developments.
Conclusions:
- Antiplatelet agents are essential in managing patients at risk of recurrent stroke.
- Current guidelines emphasize individualized selection based on efficacy, safety, and patient factors.
- The combination of aspirin and extended-release dipyridamole offers an alternative therapeutic strategy.
Abstract:
Stroke is the third leading cause of mortality in the United States. As the leading cause of neurological deficits worldwide, stroke is associated with tremendous costs both to society and to the individuals and families stroke impacts. Antiplatelet agents have demonstrated efficacy in preventing recurrent atherothrombotic strokes and are the principal pharmacologic modality employed. With the recent development of the thienopyridines and the resurgence of dipyridamole, recommendations for antiplatelet therapy have undergone several iterations over the past decade. The focus of this review is to provide an update on the individual antiplatelet agents and recapitulate the current guidelines for antiplatelet selection and use in either transient ischemic attack or noncardiogenic ischemic stroke patients. Mechanisms of action, demonstrated efficacy, adverse effect profiles, and current consensus recommendations are reviewed for four conventional antiplatelet strategies, aspirin, ticlopidine, clopidogrel, and the combination of aspirin and extended-release dipyridamole.