Prophylactic drug therapy in cerebrovascular disease

Aspirin in doses of 325 mg to 1,300 mg per day is the drug of choice for prophylactic therapy in cerebrovascular disease. Ticlopidine, a platelet antagonist, is available for use in patients who cannot tolerate aspirin or who have not had success with aspirin therapy. Although ticlopidine is more effective than aspirin in preventing stroke, its use may be somewhat limited due to cost and the uncommon but serious side effect of neutropenia. Low-dose warfarin remains the drug of choice for the prevention of cardioembolic stroke. The role of warfarin in ischemic cerebrovascular disease is unknown.