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P2Y12 receptor inhibitors for secondary prevention of ischemic stroke
Fang Liu1, Udaya S Tantry, Paul A Gurbel
1Sinai Center for Thrombosis Research, Cardiac Catheterization Laboratory , 2401 W. Belvedere Ave, Baltimore, MD 21215 , USA +1 410 601 9600 ; +1 410 601 9601 ; pgurbel@lifebridgehealth.org.
Introduction:
Ischemic stroke (IS) is a major cause of death and disability worldwide. The P2Y12 receptor plays a critical role in the formation of a stable thrombus leading to ischemic complications. Therefore, P2Y12 receptor inhibitors constitute a major antiplatelet strategy in the secondary prevention of IS.
Areas Covered:
We searched articles about P2Y12 receptor inhibitors and stroke in PubMed published until December 2014. This is a comprehensive review of the role of P2Y12 receptor inhibitors alone and in combination with aspirin in the secondary prevention of noncardioembolic stroke.
Expert Opinion:
The potential benefit of more potent antiplatelet therapy for secondary stroke prevention must be weighed against the risk of bleeding in patients with IS. Short-term (≤ 3 months) dual antiplatelet therapy with clopidogrel and aspirin that is initiated early after IS or transient ischemic attack due to large artery atherosclerosis appears most efficient.
Insights
P2Y12 receptor inhibitors are key for preventing ischemic stroke (IS) recurrence. Short-term dual therapy with clopidogrel and aspirin after IS is most effective, balancing benefits against bleeding risks.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Ischemic stroke (IS) is a leading global cause of death and disability.
- The P2Y12 receptor is crucial for thrombus formation, making its inhibitors a vital antiplatelet strategy for IS secondary prevention.
Purpose of the Study:
- To comprehensively review the role of P2Y12 receptor inhibitors in the secondary prevention of noncardioembolic stroke.
- To evaluate P2Y12 inhibitors used alone and in combination with aspirin.
Main Methods:
- Systematic literature search of PubMed for articles on P2Y12 inhibitors and stroke up to December 2014.
- Review focused on secondary prevention of noncardioembolic stroke.
Main Results:
- P2Y12 inhibitors are central to antiplatelet therapy for IS.
- Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin shows promise.
Conclusions:
- The efficacy of potent antiplatelet therapy must be balanced with bleeding risk in IS patients.
- Early initiation of short-term (≤ 3 months) DAPT with clopidogrel and aspirin is most efficient for secondary stroke prevention in large artery atherosclerosis-related IS or transient ischemic attack.
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