Antiplatelet therapy for stroke prevention.
Recent trials of antiplatelet therapy for stroke prevention indicate that the combination of clopidogrel (75 mg/d) plus low-dose aspirin (75-162 mg/d) was not more effective than low-dose aspirin alone in the long-term prevention of major vascular events among patients at high risk of atherothrombotic events, nor was it more effective than oral anticoagulation in patients with atrial fibrillation. Furthermore, oral anticoagulation (International Normalized Ratio of 2.0-3.0) was not more effective than aspirin alone among patients with recent cerebral ischemia of presumed arterial origin. However, the addition of extended-release dipyridamole to aspirin was more effective than aspirin alone among patients with recent cerebral ischemia of presumed arterial origin. A large trial comparing clopidogrel with the combination of aspirin and extended-release dipyridamole in more than 20,000 patients with recent (< 120 days) atherothrombotic ischemic stroke is expected to report in 2008.
Hankey
Graeme J
GJ
Consultant Neurologist and Head of Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6001, Australia. gjhankey@cyllene.uwa.edu.au
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D004176:Dipyridamole / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin