New Insights in Antiplatelet Therapy for Patients With Ischemic Stroke

Background: Acute treatment and long-term secondary prevention of noncardioembolic ischemic stroke and transient ischemic attack (TIA) include initiation of antiplatelet therapy. Antiplatelet agents currently used in the treatment of ischemic stroke and TIA are aspirin, clopidogrel, and dipyridamole. Review Summary: The safety and efficacy of antiplatelet therapy in patients with ischemic stroke, including a discussion of recent trial data and its influence on treatment guidelines, are presented. A brief discussion of the use of antiplatelet therapy in preventing stroke and embolism in patients with atrial fibrillation is also presented. For secondary prevention of ischemic events in patients with a history of stroke, clinical trials have shown the addition of dipyridamole to aspirin to be more effective than aspirin alone. The therapies are also similar from a standpoint of bleeding. The combination of aspirin and clopidogrel was not shown to be more efficacious and caused more bleeding than aspirin alone when evaluated for secondary prevention. However, dual antiplatelet therapy with aspirin and clopidogrel may have some benefit in the acute stroke setting or in the prevention of thrombotic events in patients with atrial fibrillation who cannot or will not take warfarin. Conclusions: Antiplatelet therapy is an important component of acute and long-term treatment of ischemic stroke and TIA. Ongoing clinical trials may help to refine what treatment regimens are best suited for acute and long-term therapy.