Clinical inquiries. What is the best management for patients who have a TIA while on aspirin therapy?
Alternative antiplatelet therapy for stroke prevention is indicated for patients who experience transient ischemic attacks (TIAs) while on aspirin therapy (strength of recommendation [SOR]: A, based on 1 meta-analysis and 1 randomized controlled trial). The combination of aspirin and extended-release dipyridamole reduces the risk of stroke following a TIA (SOR: A). Thieno-pyridines (eg, clopidogrel and ticlopidine) are an alternative for patients at high risk for a cardioembolic event. Ticlopidine reduces the risk of stroke following TIA, specifically showing benefit for patients previously on aspirin (SOR: A). Clopidogrel has not shown significant reduction in reoccurrence of stroke and has not been studied for patients with a previous TIA. Aspirin and a thieno-pyridine do not provide significant additional reduction in secondary strokes (SOR: A).
Ahmed
Nabila
N
Ferris State University/Michigan State University, East Lansing, MI, USA.
Coffey
John B
JB
Oh
Robert
R
D001241:Aspirin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin