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Current guidelines on antiplatelet agents for secondary prevention of noncardiogenic stroke: an evidence-based review

B Brent Simmons1, Albert Yeo, Kent Fung

  • 1Department of Family and Community Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA. bsimmons@drexelmed.edu

Postgraduate Medicine
|March 6, 2010
PubMed

Insights

Antiplatelet therapy, including aspirin and clopidogrel, is crucial for preventing recurrent ischemic strokes. Recent trials show clopidogrel is as effective as aspirin plus dipyridamole for secondary stroke prevention.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Antiplatelet therapy is essential for secondary prevention of ischemic strokes.
  • Several major clinical trials have advanced the understanding of antiplatelet agent utilization.

Purpose of the Study:

  • To review the current evidence on antiplatelet therapies for secondary stroke prevention.
  • To discuss the comparative effectiveness of aspirin, aspirin/dipyridamole, and clopidogrel.

Main Methods:

  • Review of key clinical trials including PRoFESS, CHARISMA, and ESPRIT.
  • Analysis of comparative efficacy data for different antiplatelet regimens.

Main Results:

  • Aspirin reduces the risk of recurrent strokes.
  • Aspirin plus dipyridamole combination therapy is superior to aspirin alone.
  • Clopidogrel is noninferior to the aspirin/dipyridamole combination and is a viable first-line option.

Conclusions:

  • Current evidence supports the use of aspirin, aspirin/dipyridamole, and clopidogrel for secondary stroke prevention.
  • Clopidogrel offers a comparable alternative to combination therapy.
  • Guidelines from the American Stroke Association and American Heart Association provide recommendations for agent selection.

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