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Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and

Jay Shah1, Shimeng Liu1,2, Wengui Yu3

  • 1Neurology, University of California, Irvine, California, USA.

Stroke and Vascular Neurology
|April 8, 2022
PubMed

Insights

Single-antiplatelet therapy (SAPT) is recommended for secondary stroke prevention. Dual-antiplatelet therapy (DAPT) offers short-term benefits for high-risk patients but carries increased bleeding risks.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Antiplatelet therapy is crucial for preventing recurrent strokes.
  • Evidence-based recommendations are essential for optimizing patient outcomes.

Purpose of the Study:

  • To review current evidence and guidelines for antiplatelet therapy in stroke prevention.
  • To highlight the efficacy and risks of different antiplatelet regimens.

Main Methods:

  • Comprehensive literature search of landmark studies and randomized controlled trials.
  • Review of systematic reviews, pooled data analyses, and meta-analyses.

Main Results:

  • Single-antiplatelet therapy (SAPT) effectively reduces recurrent ischemic stroke risk.
  • Dual-antiplatelet therapy (DAPT) for 21-30 days improves outcomes in minor stroke/high-risk TIA but increases hemorrhage risk with prolonged use.
  • Aspirin reduces stroke risk by 22%; aspirin/dipyridamole and cilostazol show superiority over aspirin but with side effects.

Conclusions:

  • SAPT is indicated for non-cardioembolic ischemic stroke or TIA.
  • Short-term DAPT followed by SAPT is recommended for minor acute non-cardioembolic stroke or high-risk TIA.
  • Therapy selection should consider patient compliance, tolerance, and resistance.

Keywords:
AsprinAtherosclerosisCerebral InfarctionStroke

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