title: New anti-thrombotic drugs for stroke prevention.
abstract: Ischemic stroke is the third most common cause of death and of long-term disability and exhibits a high recurrence rate. Therefore, appropriate primary and secondary prevention is mandatory. In non-cardioembolic stroke, in addition to lifestyle changes and to targeted treatments, current guidelines recommend antiplatelet treatment. In cardioembolic stroke, Vitamin K antagonists (VKAs) are recommended. Although a favorable risk/benefit ratio of both treatments has also been demonstrated in elderly patients, registry data emphasize that such interventions are often under-used, especially in patients with atrial fibrillation (AF). Furthermore, variability in the inter-individual response to drugs has been recognized as a leading cause of event recurrence. Thus, in addition to poor adherence, efficacy and safety issues appear to be involved in the recurrence rate of stroke. In this review, we report main Registries data on adherence to stroke prevention treatment schedule. We also discuss the major limitations of "traditional" antithrombotic drugs and report Phase III study results on safety and efficacy of new antiplatelet and anticoagulant drugs, with emphasis on stroke prevention.
authors.affiliation: Department of Clinical and Experimental Medicine, and Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy. dario.diminno@hotmail.it
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Anna
authors.initials: A
authors.lastname: Russolillo
authors.forename: Marina
authors.initials: M
authors.lastname: Camera
authors.forename: Marta
authors.initials: M
authors.lastname: Brambilla
authors.forename: Angela
authors.initials: A
authors.lastname: De Gregorio
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D055118:Medication Adherence; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000473:pathology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K