Antiplatelet therapy in cerebrovascular disorders

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Published on: March 15, 2022

Ralph Weber1, Johannes Brenck, Hans-Christoph Diener

  • 1Department of Neurology and Stroke Center, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.

Handbook of Experimental Pharmacology
|August 25, 2012
PubMed

Insights

Dual antiplatelet therapy, combining aspirin with dipyridamole or clopidogrel, shows promise for acute and long-term secondary stroke prevention. These therapies may be more effective than aspirin alone for high-risk patients.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Antiplatelet treatment is crucial for secondary stroke prevention.
  • Aspirin monotherapy is widely used but may be less effective than combination therapies.
  • Guidelines recommend dual antiplatelet therapy (DAPT) for high-risk patients.

Purpose of the Study:

  • To review the efficacy of different antiplatelet strategies in secondary stroke prevention.
  • To compare DAPT with aspirin monotherapy.
  • To discuss the role of antiplatelet agents in specific stroke etiologies.

Main Methods:

  • Review of evidence from randomized trials and current guidelines.
  • Comparison of aspirin, aspirin with dipyridamole, aspirin with clopidogrel, and oral anticoagulation.
  • Discussion of emerging antiplatelet agents.

Main Results:

  • Dual antiplatelet therapy (aspirin/dipyridamole or aspirin/clopidogrel) is more effective than aspirin monotherapy for high-risk secondary stroke prevention.
  • Oral anticoagulation is superior to antiplatelet therapy for cardioembolic stroke (e.g., due to atrial fibrillation).
  • Cilostazol shows potential but requires further study, particularly in non-Asian populations.

Conclusions:

  • DAPT is recommended for long-term secondary stroke prevention in high-risk patients.
  • The choice of therapy depends on stroke etiology (e.g., intracranial stenosis vs. cardioembolic).
  • Further research is needed on newer agents like cilostazol.

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