Advances in long-term stroke prevention with antiplatelet therapy

Stroke is a leading cause of mortality and major disability. There is considerable evidence from randomized trials that antiplatelet therapy is effective in the secondary prevention of ischemic strokes. Aspirin, the most widely evaluated agent, has consistently been found to be effective. However, higher doses are no more effective than lower doses and are associated with a higher incidence of adverse events. Clopidogrel has been shown to be more effective than aspirin in preventing recurrent ischemic events in patients with atherosclerosis manifested by ischemic stroke, myocardial infarction, or peripheral arterial disease. Ticlopidine has also been shown to be more effective than aspirin in the reduction of recurrent strokes and in the composite end point of stroke and death. Dipyridamole, in the sustained release formulation, in combination with aspirin, has been shown to be more effective than aspirin alone, particularly in the reduction of nonfatal strokes. Data from recent clinical trials has shown that there are new and effective treatment options available with antiplatelet therapy for the secondary prevention of ischemic stroke.