[EBM of cerebral infarction: message from mega-studies]

Area of Science:

• Cardiovascular Medicine
• Neurology
• Pharmacology

Background:

• Antiplatelet therapy significantly reduces vascular events in high-risk patients with obstructive vascular disease.
• Low-dose aspirin (75-150 mg) is most effective; doses below 75 mg lack proven efficacy.
• Cilostazol shows efficacy in preventing recurrent ischemic stroke, particularly in Japanese patients with lacunar stroke.

Purpose of the Study:

• To review the efficacy of antiplatelet agents and anticoagulants in preventing vascular events and stroke.
• To compare warfarin with aspirin and other agents in specific patient populations, including non-valvular atrial fibrillation (NVAF).
• To evaluate the role of anticoagulation in stroke patients with patent foramen ovale (PFO).

Main Methods:

• Meta-analysis of antiplatelet therapy by the Antithrombotic Trialists' Collaboration.
• Review of large randomized controlled trials (RCTs) like MATCH, ACTIVE, and CHARISMA.
• Analysis of studies comparing anticoagulants (warfarin, ximelagatran) and antiplatelets (aspirin) in NVAF and ischemic stroke patients.

Main Results:

• Antiplatelet therapy significantly reduces stroke, myocardial infarction (MI), and vascular death in high-risk individuals.
• Warfarin is recommended for NVAF patients over 75 or with specific risk factors; aspirin is an alternative for lower-risk patients.
• Warfarin showed no efficacy over aspirin in most ischemic stroke subtypes without NVAF, and in stroke patients with PFO.

Conclusions:

• Low-dose aspirin is a cornerstone for preventing vascular events in high-risk populations.
• Anticoagulation strategies for NVAF require careful patient selection based on stroke risk factors and age.
• The role of warfarin in stroke prevention is limited to specific conditions like NVAF and PFO with deep vein thrombosis.