Vnitr Lek 2020, 66(8):501-506 | DOI: 10.36290/vnl.2020.147

Antiplatelet therapy in secondary prevention of non‑embolic ischaemic stroke

Štefan Alušík1, Zoltán Paluch2
1 Katedra vnitřního lékařství IPVZ Praha
2 Ústav farmakologie 2. LF UK Praha

The authors address the topic of antiplatelet therapy after a non-cardioembolic ischaemic stroke. They discuss some controversial issues in therapy such as monotherapy versus combination therapy, short-term versus long-term therapy and whether current therapy should be modified or continued in the event a patient has experienced a stroke. Other outstanding issues dealt with include e.g., the risk of such therapy in patients developing cerebral microbleeds. While consensus has been reached by experts regarding the utility of dual therapy in the initial period, divergent opinions exist as to the selection of drugs and therapy duration. Definition of the optimal strategy is hindered by the lack of evidence and robust data from clinical trials.

Keywords: acetylsalicylic acid, clopidogrel, dipyridamole, dual therapy, monotherapy.

Published: December 15, 2020  Show citation

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Alušík Š, Paluch Z. Antiplatelet therapy in secondary prevention of non‑embolic ischaemic stroke. Vnitr Lek. 2020;66(8):501-506. doi: 10.36290/vnl.2020.147.
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    References

    1. Amarenco P, Lavallee PC, Labreuche J, et al. One‑year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med 2016; 374: 1533-1542. Go to original source... Go to PubMed...
    2. Zhang J, Yang Y, Sun H, et al. Hemorrhagic transformation after cerebral infarction: current concepts and challenges. Ann Transl Med 2014; 8: 81.
    3. Royal College of Physicians. National clinical guideline for stroke. Prepared by the Intercollegiate Stroke Working Party. 5th ed.2016.
    4. NICE guideline: Stroke and transient ischaemic attack in over 16 s: diagnosis and initial management (NG 128). Dostupné z WWW: https://www.nice.org.uk/guidance/ng128
    5. Rothwell PM, Cook NR, Gaziano JM, et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 2018; 392: 387-399. Go to original source... Go to PubMed...
    6. Rothwell PM, Algra A, Chen Z, et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time‑course analysis of randomised trials. Lancet 2016; 388: 365-375. Go to original source... Go to PubMed...
    7. No author listed. Minor ischaemic stroke and antiplatelet drugs. Very little advantage from adding clopidogrel to aspirin. Prescrire Int 2019; 28: 77.
    8. Karetová D, Bultas J. Cilostazol. Remedia 2014; 24: 441-449.
    9. Shi L, Pu J, Xu L, et al. The efficacy and safety of cilostazol for the secondary prevention of ischemic stroke in acute and chronic phases in Asian population- an updated meta‑analysis. BMC Neurology 2014; 14: 251. Go to original source... Go to PubMed...
    10. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143: 1-13. Go to original source... Go to PubMed...
    11. ESPRIT Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 2006; 367: 1665-1673. Go to original source... Go to PubMed...
    12. Sacco RL, Diener HC, Yusuf S, et al. PRoFESS Study Group. Aspirin and extended‑release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008; 359: 1238-1251. Go to original source... Go to PubMed...
    13. Wang MT, Liang HL, Hung CC, et al. Combination Therapy with Dipyridamole and Clopidogrel for Secondary Stroke Prevention in Aspirin‑Intolerant Patients After Myocardial Infarction: Results of a Nationwide Case‑Control Study. CNS Drugs 2019; 33: 175-185. Go to original source... Go to PubMed...
    14. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 1706-1717. Go to original source... Go to PubMed...
    15. Wang Y, Wang Y, Zhao X, et al. CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369: 11-19. Go to original source... Go to PubMed...
    16. Johnston SC, Easton JD, Farrant M, et al. Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, POINT Investigators. Clopidogrel and Aspirin in Acute Ischemic Stroke and High‑Risk TIA. N Engl J Med 2018; 379: 2015-2025. Go to original source... Go to PubMed...
    17. The SPS3 Investigators. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med 2012; 367: 817-825.
    18. Diener HC, Bogousslavsky J, Brass LM, et al. MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high‑risk patients (MATCH): randomised, double‑blind, placebo‑controlled trial. Lancet 2004; 364: 331-337. Go to original source... Go to PubMed...
    19. Bath PM, Woodhouse LJ, Appleton JP, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open‑label, phase 3 superiority trial. Lancet 2018; 391: 850-859.Další literatura u autoraa na www.casopisvnitrnilekarstvi.cz Go to original source... Go to PubMed...
    20. Amarenco P. How effective is dual antiplatelet therapy for secondary prevention of ischemic stroke? www.thelancet.com 2018; 391: 819-821.
    21. Yusuf S, Zhao F, Mehta SR, et al. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST‑segment elevation. N Engl J Med 2001; 345: 494-502. Go to original source... Go to PubMed...
    22. Steinhubl SR, Berger PB, Mann JT 3rd, et al. CREDO Investigators. Clopidogrel for the Reduction of Events During Observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288: 2411-2420. Go to original source... Go to PubMed...
    23. Wein T, Lindsay MP, Côté R, et al. Canadian stroke best practice recommendations: Secondary prevention of stroke, sixth edition practice guidelines, update 2017. Int J Stroke 2018; 13: 420-443. Go to original source... Go to PubMed...
    24. Bibbins‑Domingo K. U.S. Preventive Services Task Force. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016; 164: 836-845. Go to original source... Go to PubMed...
    25. Mazlan‑Kepli W, Macisaac RL,Walters M, et al. VISTA Collaborators. Antiplatelet therapy following ischaemic stroke‑Continue or change pre‑existing therapy? European Stroke Journal 2017; 2: 31-36. Go to original source... Go to PubMed...
    26. Lee M, Saver JL, Hong KS, et al. Antiplatelet Regimen for Patients With Breakthrough Strokes While on Aspirin: A Systematic Review and Meta‑Analysis. Stroke 2017; 48: 2610-2613. Go to original source... Go to PubMed...
    27. Nelson S, Cloonan L, Kanakis AS, et al. Antecedent Aspirin Use Is Associated with Less Severe Symptoms on Admission for Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25: 2519-2525. Go to original source... Go to PubMed...
    28. Oh MS, Yu KH, Lee JH, et al. Aspirin resistance is associated with increased stroke severity and infarct volume. Neurology 2016; 86: 1808-1817. Go to original source... Go to PubMed...
    29. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49: e46-e110. Go to original source... Go to PubMed...
    30. Wilson D, Ambler G, Shakeshaft C, et al. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol 2018; 17: 539-547. Go to original source... Go to PubMed...
    31. Lau KK, Lovelock CE, Li L, et al. Antiplatelet Treatment After Transient Ischemic Attack and Ischemic Stroke in Patients With Cerebral Microbleeds in 2 Large Cohorts and an Updated Systematic Review. Stroke 2018; 49: 1434-1442. Go to original source... Go to PubMed...
    32. Hao Q. Antiplatelet in Patients with Microbleeds: Prevent Ischemic Stroke or Precipitate Hemorrhage? Blogging Stroke 2018. Dostupné z WWW https://journals.heart.org/bloggingstroke/2018/08/10/antiplatelet‑in‑patients‑with‑microbleeds‑prevent‑ischemic‑stroke‑or‑precipitate‑hemorrhage/
    33. Aoki J, Iguchi Y, Urabe T, et al. Acute Aspirin Plus Cilostazol Dual Therapy for Noncardioembolic Stroke Patients Within 48 Hours of Symptom Onset. J Am Heart Assoc. 2019; 8: e012652. Go to original source... Go to PubMed...
    34. Chi NF, Wen CP, Liu CH, et al. Comparison between aspirin and clopidogrel in secondary stroke prevention based on real‑world data. Am Heatr Assoc 2018; 7: e009856. Go to original source... Go to PubMed...
    35. Johnston SC, Amarenco P, Alberts GW, et al. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. N Engl J Med 2016; 375: 35-43. Go to original source... Go to PubMed...
    36. Eikelboom JW, Connolly SJ, Bosch J, COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med 2017; 377: 1319-1330. Go to original source... Go to PubMed...
    37. Bultas J, Karetová D. Enterosolventní forma kyseliny acetylsalicylové - ano, či ne? Remedia 2017; 27: 145-151.
    38. Jirmar R, Widimský P. Enteric‑coated aspirin in cardiac patients: Is it less effective than plain aspirin? Cor et Vasa 2018; 60: e165-e168. Go to original source...

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