ORAL ANTIPLATELET THERAPY IN STROKE PREVENTION. MINIREVIEW

Michal Kral,Roman Herzig,David Skoloudik,Petr Kanovsky,Ivanka Vlachova,Petr Hlustik,Andrea Bartkova,Michal Kovacik,Daniel Sanak

doi:10.5507/bp.2010.031

Abstract

Antiplatelet therapy plays a crucial role in the primary and secondary prevention of noncardioembolic ischemic stroke / transient ischemic attacks (IS/TIA). Several antiplatelet agents are available. This review deals with the characteristics of particular antiplatelet agents as well as choice of antiplatelet treatment in various situations, based on the evidence and international recommendations. PubMed and Stroke Trials Registry on-line databases and the European Stroke Organisation Guidelines for Management of IS/TIA 2008 and update of the recommendations of the American Heart Association / American Stroke Association Council 2008 on Stroke were used. Acetylsalicylic acid (ASA) is the only antiplatelet drug used in primary prevention, mainly to reduce the risk of myocardial infarction (MI), but also in women aged 45 years or more and in some patients with non-valvular atrial fibrillation to reduce risk of IS/TIA. In the secondary prevention of noncardioembolic IS/TIA, ASA in combination with long release dipyridamole (DIP) and clopidogrel (CLOP) alone are considered first choice therapies. The choice of the particular antiplatelet agent should be individualized according to the patient risk factor profiles and treatment tolerance. ASA alone or triflusal can be used alternatively in patients who cannot be treated with either ASA+DIP or CLOP. The use of indobufen should be considered only in patients in need of temporary interruption of the antiplatelet therapy. Ticlopidine (TIC) should not be newly introduced into the treatment. Currently, insufficient data are available on the use of cilostazol in IS/TIA prevention.

Highlights

Stroke is one of the leading causes of morbidity and mortality worldwide[1] and is the most important cause of morbidity and long-term disability in Europe, and demographic changes will result in the increase of both the incidence and the prevalence
The dual antiplatelet therapy with CLOP + acetylsalicylic acid (ASA) is not recommended for the secondary prevention of ischemic stroke (IS)/TIA with the above mentioned exceptions[10,11], this therapy was associated with a significant decrease in number of asymptomatic microembolic events, as assessed by transcranial Doppler (TCD) examination, found in patients with carotid stenosis ≥ 50%, who experienced an ischemic stroke / transient ischemic attacks (IS/TIA) in the ipsilateral carotid territory within the last 3 months, in the CARESS study[36], and with a significant reduction of the number of such events detected by TCD within 3 hours after carotid endarterectomy, as reported by Payne et al.[37]
Primary prevention According to the European Stroke Organisation (ESO) Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008(ref.10), low dose ASA is recommended in women aged 45 years or more who are not at increased risk for intracerebral haemorrhage and who have good gastrointestinal tolerance; its effect is very small

Summary

Background

Antiplatelet therapy plays a crucial role in the primary and secondary prevention of noncardioembolic ischemic stroke / transient ischemic attacks (IS/TIA). This review deals with the characteristics of particular antiplatelet agents as well as choice of antiplatelet treatment in various situations, based on the evidence and international recommendations

Methods

Results

INTRODUCTION

CONCLUSION