Antiplatelet Treatment in Stroke: New Insights.

Abstract

Stroke is a feared vascular event among healthy people and those with cardiovascular disease, and holds a leading position as a cause of disability and death worldwide. Antiplatelet therapy is central in the management of patients with ischemic nonembolic stroke and transient ischemic attacks. In this narrative review, we provide an overview and update of evidence regarding antiplatelet treatment in the primary and secondary prevention of stroke. Aspirin, clopidogrel and aspirin plus dipyridamole are the mainstays of antiplatelet treatment post-stroke, while promising agents include triflusal, cilostazol and ticagrelor. Available data are in favor of dual antiplatelet treatment in the early treatment of atherosclerotic large vessel disease. Long-term dual antiplatelet treatment should be individualized keeping in mind the higher rates of bleeding complications. Treatment with an antiplatelet agent is recommended to reduce recurrent stroke and death in patients with a non-cardioembolic ischemic stroke or transient ischemic attack. Moreover, clinicians should carefully assess the pros and cons in each case and individualize the need for prolonged dual antiplatelet therapy.