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Antiplatelet therapy to prevent recurrent stroke: Three good options

Antiplatelet therapy offers benefit in the primary and secondary prevention of stroke, with a 25% reduction in the rate of nonfatal stroke and a 17% reduction in the rate of death due to vascular causes.

Aspirin is the best established

Aspirin is the best established, best tolerated, and least expensive of the three contemporary agents. Further, it is also the agent of choice for acute stroke care, to be given within 48 hours of a stroke to mitigate the risk of death and morbidity. The data for other agents in acute stroke management remain limited.

Aspirin plus dipyridamole

Aspirin plus dipyridamole is slightly…

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Featured

 Are Three Antiplatelet Agents Better Than One or Two for Recurrent Stroke Prevention?

Antithrombotic therapy use is predicated on prevention of ischemic events outweighing any increase in bleeding. These findings show that there are limits to combining multiple antithrombotic agents. In patients with a recent stroke or TIA, triple therapy had no demonstrable benefit for stroke prevention, and significant bleeding events occurred at an excess rate with triple therapy. Sometimes “less is more,” or at least better for the patient.

 Dual or Mono Antiplatelet Therapy for the Prevention of Ischemic Stroke: A Literature Review

The role of dual antiplatelet (aspirin and clopidogrel) in patients with a recent TIA (within 30 days) or severe stenosis (70%–99%) of a major intracranial artery, for 90 days, might be a beneficial approach.

Articles of Interest

Antiplatelet Agents for Stroke Prevention

Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.

Antiplatelet Drugs

The article describes the mechanisms of action, pharmacokinetics, and pharmacodynamics of aspirin, dipyridamole, cilostazol, the thienopyridines, and the glycoprotein IIb/IIIa antagonists.

Antiplatelets in Secondary Stroke Prevention

The aim of this review is to provide evidence-based recommendations on the secondary prevention of atherothrombotic ischemic stroke. Antiplatelets are the major therapy for the secondary stroke prevention. The most commonly used antiplatelets agents are aspirin, clopidogrel, and extended-release dipyridamole.

Antithrombotic and thrombolytic therapy for ischemic stroke...

In patients with a history of noncardioembolic ischemic stroke or TIA, we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy (Grade 1A), oral anticoagulants (Grade 1B), the combination of clopidogrel plus aspirin (Grade 1B), or triflusal (Grade 2B). Of the recommended antiplatelet regimens, we suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (Grade 2B) or cilostazol (Grade 2C).

Best blood thinners to prevent heart attack and stroke

This report evaluates the use of antiplatelet drugs in preventing heart attacks, strokes, and premature death in people who have acute coronary syndrome (unstable angina or had a heart attack), peripheral vascular disease, a stent, or previously had a stroke. Five of these medications are evaluated in this report: aspirin, a fixed combination of aspirin plus extended-release dipyridamole (Aggrenox), clopidogrel (Plavix), prasugrel (Effient), and ticlopidine (Ticlid and generic).

Dos and Don'ts of Antiplatelet Use for Secondary Stroke Prevention

In light of these findings, the AHA suggests that the combination of clopidogrel and aspirin might be considered within 24 hours of a minor ischemic stroke or TIA and continued for up to 21 days

Expert Consensus on Switching Antiplatelet Therapies

The following are key points to remember about this international expert consensus document on switching platelet P2Y12 receptor-inhibiting therapies...

How Aspirin Works Its Magic

In 1982, the British chemist Sir John Vane shared the Nobel Prize in Medicine in part for figuring out how aspirin worked, but some researchers now think that his work may have been only a good beginning.

Oral antiplatelet therapy for acute ischaemic stroke

The review provided strong evidence for the benefits ofaspirin 160 to 300 mg, given as soon as is practicable (andcontinued as a once daily dose), in people with suspected acuteischaemic stroke. This evidence applied chiefly to people seenwithin 48 hours of stroke onset and in whom intracranialhaemorrhage had been excluded...

Resources

GlobalRPH

All the major antiplatelet drugs and their indications.

Pharmacology Corner

An overview on antiplatelet drugs, we will focus on the classification of agents and their mechanism of action. The most relevant facts related to therapeutics will also be discussed...

Aggrenox

AGGRENOX combines two medications–aspirin and extended-release dipyridamole. This combination is better than either medication alone at reducing the risk of another stroke. The 2 medications are known as antiplatelets, and they work together to make platelets in the blood less sticky, so they are less likely to clump together and form blood clots.

Dipyridamole

Dipyridamole is used with other drugs to reduce the risk of blood clots after heart valve replacement. It works by preventing excessive blood clotting.

Plavix

Clopidogrel bisulfate is an anti-platelet drug, that is, a drug that inhibits the ability of platelets to clump together as part of a blood clot. Clopidogrel prevents blood clots by irreversibly binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from activating platelets. It belongs to a class of drugs called P2Y12 inhibitors.

Ticlid

Ticlopidine (trade name Ticlid) is an antiplatelet drug in the thienopyridine family. Like clopidogrel, it is an adenosine diphosphate (ADP) receptor inhibitor. It is used in patients in whom aspirin is not tolerated, or in whom dual antiplatelet therapy is desirable. Because it has been reported to increase the risk of thrombotic thrombocytopenic purpura (TTP) and neutropenia, its use has largely been supplanted by the newer drug, clopidogrel, which is felt to have a much lower hematologic risk. The usual dose is 250 mg twice daily by the oral route.