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Recurrent Stroke while on Antiplatelet Therapy.

Seby John1, Irene Katzan2

  • 1Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.

Neurologic Clinics
|April 25, 2015
PubMed
Summary
This summary is machine-generated.

Recurrent strokes are common, with many occurring despite antiplatelet therapy. Current guidelines do not recommend antiplatelet resistance testing for ischemic stroke management.

Keywords:
AntiplateletsIschemic strokeRecurrenceResistanceTreatment failure

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Approximately 795,000 strokes occur annually in the US, with 185,000 being recurrent.
  • A significant proportion of recurrent strokes (33-50%) happen while patients are on antiplatelet therapy.
  • Breakthrough strokes on antiplatelet therapy may stem from various underlying causes and mechanisms.

Purpose of the Study:

  • To investigate the reasons for recurrent ischemic stroke in patients undergoing antiplatelet therapy.
  • To evaluate the current clinical practice regarding antiplatelet resistance testing in stroke management.
  • To review the efficacy of dual antiplatelet therapy for secondary stroke prevention.

Main Methods:

  • Review of existing literature on recurrent stroke and antiplatelet therapy.
  • Analysis of recent clinical trial data on dual antiplatelet therapy regimens.
  • Examination of current guidelines for managing ischemic stroke.

Main Results:

  • No established indication exists for antiplatelet resistance testing in ischemic stroke.
  • Dual antiplatelet therapy demonstrates effectiveness in the acute phase after an ischemic event.
  • Long-term secondary prevention benefits from dual antiplatelet therapy have not been established.

Conclusions:

  • Recurrent strokes on antiplatelet therapy necessitate thorough etiological investigation.
  • Antiplatelet resistance testing is not currently recommended for guiding stroke management.
  • Dual antiplatelet therapy is beneficial acutely but not for long-term secondary prevention of stroke.