Antiplatelet Therapy in Noncardioembolic Stroke: A Review of Current Evidence

Kailash Krishnan; Mirza Jusufovic; Per Morten Sandset; Else Charlotte Sandset

doi:10.1055/s-0037-1603469

Seminars in Neurology, Table of Contents

Semin Neurol 2017; 37(03): 366-375
DOI: 10.1055/s-0037-1603469

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antiplatelet Therapy in Noncardioembolic Stroke: A Review of Current Evidence

Kailash Krishnan^*

¹Division of Clinical Neuroscience, Department of Stroke, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

,

Mirza Jusufovic^*

²Department of Neurology, Oslo University Hospital, Oslo, Norway

,

Per Morten Sandset

³Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway

,

Else Charlotte Sandset

²Department of Neurology, Oslo University Hospital, Oslo, Norway

› Author Affiliations

Abstract

Acute stroke is a leading cause of death and disability in the developed world. Among survivors, the risk of stroke recurrence is highest within the first few days, and up to 15% will be affected within the first year. In the case of noncardioembolism, antiplatelets, such as aspirin, clopidogrel, and the combination of aspirin and dipyridamole, remain the mainstay of treatment. Aspirin given immediately is beneficial, but when combined with clopidogrel is associated with a higher risk of bleeding. Dual antiplatelet therapy of aspirin and dipyridamole was no more effective than clopidogrel in reducing stroke recurrence. In symptomatic extracranial atherosclerosis, surgery within 2 weeks of the index event will benefit, but in strokes due to intracranial atherosclerosis and small vessel disease, medical therapy alone is recommended. The purpose of this review is to discuss the various trials of antiplatelet therapies in acute and long-term stroke prevention in mechanisms excluding cardioembolism.

Keywords

ischemic stroke - antiplatelets - stroke prevention - recurrent stroke

Full Text

References

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