Recent clinical trials of antiplatelet therapy in secondary stroke prevention: expectations and results for application in primary care settings.
Antiplatelet therapies significantly reduce the risk of secondary noncardioembolic ischemic stroke. First-line treatment for secondary stroke prevention involves the use of antiplatelet drugs over oral anticoagulation therapies; antiplatelet treatment options include aspirin, aspirin in combination with extended-release dipyridamole (ER-DP), or clopidogrel. Aspirin plus ER-DP has been shown to be effective for secondary stroke prevention, whereas aspirin plus clopidogrel offers no additive benefits and is associated with safety issues. During the past several years, significant progress has been made in secondary stroke prevention, which continues to be an active area of interest. Today's primary care physicians are challenged with keeping abreast of new findings and ensuring that guideline-recommended therapies are initiated and maintained as indicated. It is important that primary care physicians be knowledgeable of the evidence by which clinical practice guidelines have been developed and on which their treatment decisions are based. In the future, antiplatelet treatment may be tailored based on patient risk. Forthcoming trial data may offer additional insight into the roles of antiplatelet agents and appropriate identification and treatment of different patient types. This review provides primary care physicians with timely evidence- and guideline-based recommendations on prevention of secondary stroke.
Lutsep
Helmi L
HL
Department of Neurology, Oregon Stroke Center, Oregon Health and Science University, Portland, Oregon 97239, USA. lutseph@ohsu.edu