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A Clinical Update on Antiplatelet Therapy in Secondary Prevention of Ischemic Stroke

Katelyn Marsden1, Hannah Y Mak2, C Patrick Crooks3

  • 1Department of Neurology, University of Washington, Seattle, SA, USA. krlm@uw.edu.

Current Cardiology Reports
|August 19, 2021
PubMed

Insights

Dual antiplatelet therapy effectively prevents recurrent stroke in patients with non-cardioembolic ischemic stroke or transient ischemic attack (TIA). Genetic factors may influence treatment effectiveness, and optimal duration requires further study.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Antiplatelet therapy is crucial for secondary stroke prevention.
  • Non-cardioembolic ischemic stroke and transient ischemic attack (TIA) management relies on antiplatelet agents.

Purpose of the Study:

  • To review clinical trials and meta-analyses on antiplatelet agents for secondary stroke prevention.
  • To provide commentary on current practices in antiplatelet therapy for stroke prevention.

Main Methods:

  • Review of key clinical trials (POINT, CHANCE, THALES) and meta-analyses.
  • Analysis of dual antiplatelet therapy versus aspirin monotherapy.
  • Consideration of genetic polymorphisms' impact on treatment efficacy.

Main Results:

  • Dual antiplatelet therapy (aspirin plus P2Y12 inhibitors like clopidogrel or ticagrelor) reduced recurrent stroke compared to aspirin alone.
  • Sub-analyses suggest genetic polymorphisms may affect clopidogrel effectiveness.
  • Ticagrelor-aspirin combination showed better outcomes than aspirin monotherapy in THALES.

Conclusions:

  • Combination antiplatelet therapy is effective in reducing stroke recurrence for mild ischemic stroke or high-risk TIA.
  • Genetic factors may influence the choice of antiplatelet regimen.
  • Optimal duration of combination therapy for different stroke etiologies needs further investigation.
Abstract

Keywords:
Antiplatelet therapyAspirinClopidogrelIschemic strokeSecondary prevention

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