title: Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke.
abstract: Ischemic stroke represents one of the leading causes of death and disability in both the United States and abroad, particularly for patients with prior ischemic stroke or transient ischemic attack (TIA). A quintessential aspect of secondary stroke prevention is the use of different pharmacological agents, mainly antiplatelets and anticoagulants. Antiplatelets and anticoagulants exhibit their effect by blocking the activation pathways of platelets and the coagulation cascade, respectively. Clinical trials have demonstrated the safety and efficacy of antiplatelets for noncardioembolic stroke prevention, while anticoagulants are more often used for cardioembolic stroke prevention. Commonly used antiplatelets include aspirin, clopidogrel, and aggrenox (aspirin plus extended-release dipyridamole). Furthermore, commonly used anticoagulants include warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban. Each of these drugs has a unique mechanism of action, and they share some common adverse events such as gastrointestinal bleeding and intracranial hemorrhage in more serious cases. Consequently, physicians should carefully assess the benefits and risks of using different antiplatelet or anticoagulant therapies when managing patients with previous ischemic stroke or TIA. This review discuses the published literature on major clinical trials assessing the efficacy of different antiplatelet and anticoagulant drugs under varying circumstances and the subsequent guidelines that have been developed by the American Heart Association/American Stroke Association. Additionally, the role of imaging in stroke prevention is discussed.
authors.affiliation: 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kapil
authors.affiliation: 2 Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Yvonne H
authors.initials: YH
authors.lastname: Datta
authors.affiliation: 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Naila
authors.initials: N
authors.lastname: Alakbarova
authors.affiliation: 3 Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Bershad
authors.affiliation: 4 Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Magdy
authors.initials: M
authors.lastname: Selim
authors.affiliation: 5 Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Ornina
authors.initials: O
authors.lastname: Bachour
authors.affiliation: 6 Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Gundu H R
authors.initials: GHR
authors.lastname: Rao
authors.affiliation: 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA.|7 Department of Neurological Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Afshin A
authors.initials: AA
authors.lastname: Divani
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: anticoagulant therapy; antiplatelet therapy; imaging; ischemic stroke; prevention; stroke