title: Pharmacokinetic considerations for antithrombotic therapies in stroke.
abstract: BACKGROUND
  Strategies to prevent stroke recurrences and stroke-related morbidity and mortality are a major concern for healthcare systems worldwide. Antithrombotic therapy is the cornerstone for the secondary prevention of ischemic stroke.
  
  
  METHODS
  This article is an overview of currently used antithrombotic therapies in the management of ischaemic stroke with special focus on their pharmacokinetic properties and how these properties may influence their clinical utility. This review covers both antiplatelet drugs and antitcoagulants used in the primary and secondary prevention of ischaemic stroke.
  
  
  CONCLUSIONS
  The role of aspirin in the early management of stroke is well established. Furthermore, antiplatelet drugs (aspirin, aspirin/dypiridamol and clopidogrel) are the cornerstone of secondary prevention of ischaemic stroke, while their role in the primary prevention is less well established. There are limited data on the use of novel antiplatelet agents for the management of stroke patients. Anticoagulation has not been associated with clinical benefits when used early in the management of acute ischaemic stroke. Long-term therapy with vitamin K antagonists provides prognostic benefit in patients with atrial fibrillation and additional stroke risk factors. New oral anticoagulants have demonstrated at least similar efficacy with vitamin K anatagonists in preventing stroke in patients with atrial fibrillation.
authors.affiliation: University of Birmingham, Centre for Cardiovascular Sciences, City Hospital , Birmingham , UK +44 121 507 5086 ; +44 121 544 4083 ; s.apostolakis@bham.ac.uk.
authors.forename: Stavros
authors.initials: S
authors.lastname: Apostolakis
authors.forename: Gregory Yh
authors.initials: GY
authors.lastname: Lip
authors.forename: Eduard
authors.initials: E
authors.lastname: Shantsila
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000493:pharmacokinetics; D001241:Aspirin / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology; D000077407:Cilostazol; D000077144:Clopidogrel; D015951:Factor Xa / Q000378:metabolism; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000493:pharmacokinetics*; D006801:Humans; D010879:Piperazines / Q000493:pharmacokinetics; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics; D000068799:Prasugrel Hydrochloride; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D013777:Tetrazoles / Q000493:pharmacokinetics; D013876:Thiophenes / Q000493:pharmacokinetics; D013917:Thrombin / Q000037:antagonists & inhibitors / Q000378:metabolism; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D013876:Thiophenes; D014812:Vitamin K; D000077144:Clopidogrel; D013917:Thrombin; D015951:Factor Xa; D000068799:Prasugrel Hydrochloride; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin