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Antithrombotic Therapy in Preventing Ischemic Stroke

Factors to consider when choosing an antithrombotic agent include type of ischemic stroke, whether the patient is at risk of major bleeding, whether genetic polymorphism affects the antithrombotic, how long to treat, whether to use dual antiplatelet therapy (DAPT) or monotherapy, and potential for nonadherence. If antithrombotics are used for secondary prophylaxis, it is important to determine when to initiate antithrombotic therapy following the acute event and whether the patient is at risk of hemorrhagic transformation.

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 Drug combo may ease near-term risk of second stroke

For people who have had a minor stroke or a transient ischemic stroke (TIA), combining the clot-preventing drug clopidogrel with aspirin may lower risk of having a major event within the next 90 days, new research shows.

Articles of Interest

Antithrombotic dilemmas in stroke medicine: new data, unsolved challenges

Antithrombotic therapy is a key element of secondary prevention in patients who have had an ischaemic stroke or transient ischaemic attack. However, its use in clinical practice is not always straightforward. This review provides an update on certain difficult scenarios in antithrombotic management, with a focus on recent clinical trials and large observational studies. We discuss the approach to patients with an indication for antithrombotic treatment who also have clinical or radiological evidence of previous intracranial bleeding, patients with indications for both anticoagulant and antiplatelet treatment, and patients in whom antithrombotic treatment fails to prevent stroke. We also review the timing of anticoagulation initiation after cardioembolic stroke, and the use of antithrombotics in patients with asymptomatic cerebrovascular disease. Despite a wealth of new evidence, numerous uncertainties remain and we highlight ongoing trials addressing these.

Antithrombotic Therapy for Prevention of Ischemic Stroke: Key Points

Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin or ticagrelor and aspirin is indicated for a short time (~21 days) after minor acute ischemic stroke or transient ischemic attack. Antiplatelet monotherapy should be initiated after the short course of DAPT is completed.

Antithrombotic Therapy in the Prevention of Stroke

Antithrombotic agents, either antiplatelet or anticoagulant, are a main stay of the prevention of ischemic stroke [1]. Evolving information has brought to the forefront the selection of dual antiplatelet therapy, such as aspirin and clopidogrel or aspirin and ticagrelor, in the acute setting of minor ischemic stroke or TIA if no clear contraindications are encountered. An embolic mechanism often calls for consideration of anticoagulant therapy, but this is impacted by the scenario such as high-grade carotid stenosis associated to artery-to-artery embolism, which generally is most effectively managed either with timely carotid endarterectomy or carotid angioplasty with stenting.

Blood-thinning drugs designed to cut stroke risk may actually increase it

Scientists call for caution in prescribing anticoagulants after some patients with other conditions found to suffer more strokes.

Difficulties in Antithrombotic Choices in Prevention of Stroke Recurrence: Combination Antiplatelet and Anticoagulant Therapies

Antiplatelet monotherapy, traditionally using aspirin, has been the mainstay in the medical management of noncardioembolic stroke. Three clinical trials—Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT), Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE), and The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA (Acetylsalicylic Acid) for Prevention of Stroke and Death (THALES)—support the use of PY12 inhibitors (clopidogrel or ticagrelor) along with low-dose aspirin for TIA or acute ischemic stroke.

Drug Treatment of Acute Ischemic Stroke

We discuss the medications related to ischemic stroke care in the context of the overall treatment approach towards the patient. This approach consists of four main goals...

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Heart & Stroke

There are several kinds of medications that doctors may administer or prescribe to a stroke patient: tPA, a clot buster; blood thinners; and drugs that lower high blood pressure and cholesterol.