[Antiplatelet therapy for secondary prevention of cerebral infarction]

Antiplatelet therapy is indicated for secondary prevention of non cardioembolic ischemic stroke. The administration of aspirin (or other antiplatelet agents) as an adjunctive therapy within 24 hours of intravenous fibrinolysis is not recommended. In the acute stage, intravenous administration of ozagrel sodium (thromboxane A2 synthase inhibitor) is approved in Japan. Dual antiplatelet therapy such as aspirin plus clopidogrel may be acceptable according to the data of CHANCE. In the chronic stage of cerebral infarction, monotherapy (aspirin, clopidogrel or cilostazol) is recommended. Selection among 3 agents should be based on relative effectiveness, safety, cost, patients' characteristics, and patients' preference. Dual antiplatelet therapy is limited in patients with high risk, post carotid stenting, etc.