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Antiplatelet Treatment in Stroke: New Insights
Haralampos Milionis, Angelos Liontos, Kostantinos Vemmos
11st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Greece.
Insights
Antiplatelet therapy is crucial for preventing recurrent stroke and death, especially after ischemic stroke or transient ischemic attack. Dual antiplatelet treatment shows promise but requires careful consideration of bleeding risks.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Stroke is a leading cause of global disability and mortality.
- Antiplatelet therapy is fundamental in managing ischemic stroke and transient ischemic attacks.
Purpose of the Study:
- To review and update evidence on antiplatelet treatment for stroke prevention.
- To discuss primary and secondary stroke prevention strategies.
Main Methods:
- Narrative review of existing scientific literature.
- Analysis of evidence for various antiplatelet agents and treatment durations.
Main Results:
- Aspirin, clopidogrel, and aspirin plus dipyridamole are standard post-stroke treatments.
- Dual antiplatelet therapy is favored in early atherosclerotic large vessel disease.
- Long-term dual antiplatelet therapy necessitates individualized risk-benefit assessment due to bleeding risks.
Conclusions:
- Antiplatelet agents are recommended to reduce recurrent stroke and mortality in non-cardioembolic ischemic stroke/TIA.
- Individualized assessment of prolonged dual antiplatelet therapy is essential, balancing efficacy and bleeding risk.
Background:
Stroke is a feared vascular event among healthy people and those with cardiovascular disease, and holds a leading position as a cause of disability and death worldwide. Antiplatelet therapy is central in the management of patients with ischemic nonembolic stroke and transient ischemic attacks.
Methods:
In this narrative review, we provide an overview and update of evidence regarding antiplatelet treatment in the primary and secondary prevention of stroke.
Results:
Aspirin, clopidogrel and aspirin plus dipyridamole are the mainstays of antiplatelet treatment post-stroke, while promising agents include triflusal, cilostazol and ticagrelor. Available data are in favor of dual antiplatelet treatment in the early treatment of atherosclerotic large vessel disease. Long-term dual antiplatelet treatment should be individualized keeping in mind the higher rates of bleeding complications.
Conclusion:
Treatment with an antiplatelet agent is recommended to reduce recurrent stroke and death in patients with a non-cardioembolic ischemic stroke or transient ischemic attack. Moreover, clinicians should carefully assess the pros and cons in each case and individualize the need for prolonged dual antiplatelet therapy.
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