Antithrombotic therapies for stroke prevention.
Aspirin is the most widely used antiplatelet agent, reducing nonfatal ischemic stroke by 22%. There is increasing evidence that the efficacy of aspirin may vary with the etiologic subtype of stroke. Although the cost and side effects have limited the use of ticlopidine, patients who are intolerant of aspirin and those experiencing transient ischemic attack or stroke during aspirin therapy should be given ticlopidine. Patients with atrial fibrillation have a five-fold increased risk of stroke and require prophylactic therapy with warfarin or aspirin. Aspirin is less effective than warfarin in preventing atrial fibrillation-associated stroke, but the higher risk of hemorrhagic complications and frequent monitoring associated with warfarin must be considered. Clinical and echocardiographic predictors of increased thromboembolic risk in atrial fibrillation patients have been identified and may direct the treatment choice.
Solomon
D H
DH
Department of Medicine, University of Texas Health Science Center, San Antonio 78284.
Hart
R G
RG
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000150:complications; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D013988:Ticlopidine; D001241:Aspirin