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Antiplatelet Therapy in Cerebral Small Vessel Disease

Danielle de Sa Bouasquevisque1, Oscar R Benavente2, Ashkan Shoamanesh3

  • 1Marta and Owen Boris Chair in Stroke Research and Care, Hemorrhagic Stroke Research Program, C4-118, David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University/Population Health Research Institute, 237 Barton St. East, Hamilton, Ontario, L9G 1J8, Canada.

Current Neurology and Neuroscience Reports
|July 29, 2019
PubMed
Abstract

Insights

Single antiplatelet therapy significantly reduces recurrent stroke risk in patients with lacunar stroke. This approach appears safe and effective, even in those with cerebral small vessel disease or prior hemorrhage.

Area of Science:

  • Neurology
  • Cardiovascular Research
  • Stroke Medicine

Background:

  • Lacunar stroke and cerebral small vessel disease (CSVD) are significant causes of recurrent stroke.
  • Effective secondary prevention strategies are crucial for managing these conditions.

Purpose of the Study:

  • To critically evaluate the evidence for antiplatelet therapy in preventing recurrent stroke after lacunar stroke.
  • To assess the utility of antiplatelet therapy in patients with hemorrhage-prone CSVD.

Main Methods:

  • Pooled subgroup analyses of randomized controlled trials (RCTs) involving patients with lacunar stroke.
  • Review of current data regarding antiplatelet use in patients with CSVD and hemorrhage history.

Main Results:

  • Single antiplatelet therapy demonstrated a 22% relative risk reduction in recurrent stroke compared to placebo.
  • No significant difference in efficacy was observed among specific antiplatelet agents.
  • Dual antiplatelet therapy did not show a clear benefit over single therapy.
  • Antiplatelet therapy is not contraindicated in patients with cerebral microbleeds or prior intracerebral hemorrhage.

Conclusions:

  • Antiplatelet monotherapy provides sustained secondary stroke prevention for lacunar stroke patients.
  • Further research is warranted to explore the potential benefits of phosphodiesterase inhibitors, like cilostazol, in CSVD.
  • Current evidence supports the use of antiplatelet therapy as a cornerstone of secondary stroke prevention in this population.
Keywords:
AntiplateletAntithromboticCerebral small vessel diseaseIntracerebral hemorrhageLacunar strokeMicrobleed

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