[Current opportunities for secondary prevention of atherothrombotic stroke]

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Atherothrombotic stroke poses a significant medical and social challenge, necessitating effective secondary prevention strategies.
• Current evidence explores the role of combined antiplatelet and anticoagulant therapy in managing this condition.

Purpose of the Study:

• To evaluate the efficacy of dual-pathway inhibition using rivaroxaban and acetylsalicylic acid (ASA) for secondary prevention of atherothrombotic stroke.
• To compare the outcomes of combination therapy versus ASA monotherapy in patients with established atherosclerotic diseases.

Main Methods:

• The study analyzed data from the COMPASS trial, comparing a dual-pathway inhibition regimen (rivaroxaban + ASA) against ASA monotherapy.
• Patient outcomes included the total risk of stroke, cardiovascular death, myocardial infarction, and recurrent ischemic stroke (IS).

Main Results:

• Combination therapy reduced the total risk of stroke, cardiovascular death, and myocardial infarction by 24%.
• The risk of recurrent stroke was significantly decreased by 67% with combination therapy (1.1% annually vs. 3.4% annually for ASA).
• The incidence of adverse outcomes within the 'net clinical benefit' indicator was 20% lower in the rivaroxaban + ASA group.

Conclusions:

• Combined antiplatelet and anticoagulant therapy, specifically rivaroxaban with ASA, demonstrates significant advantages in preventing recurrent noncardioembolic ischemic stroke.
• Dual-pathway inhibition offers superior secondary prevention for patients with atherosclerotic diseases, improving overall clinical outcomes.