Antiplatelet agents for secondary prevention of ischemic stroke

OBJECTIVE, To review and summarize the efficacy, mechanisms of action, and cost of the options available when choosing antiplatelet agents for seconda ry stroke prevention. DATA SOURCES: This article is based on a review of the literature found wit h MEDLINE, CINAHL, and Cochrane Reviews (1980-June 2000) and abstracts from relevant international scientific meetings. We searched for the terms aspi rin, ticlopidine, dipyridamole, antiplatelet, and clopidogrel. STUDY SELECTION: English-language articles, both reviews and original studi es, were evaluated, and all information considered relevant was included in this review. In addition, guidelines from the American Heart Association a re Included. DATA SYNTHESIS; Aspirin is a relatively inexpensive and effective agent fbr secondary stroke prevention, and lower doses of aspirin appear as effectiv e as higher doses. Ticlopidine has been used alone or in combination with a spirin, but serious adverse effects have limited its use. Clopidogrel has e merged as a safe and effective alternative to ticlopidine and lacks some of the serious adverse effects associated with ticlopidine, but is not superi or to aspirin in secondary stroke prevention. Unlike previous studies, one recent trial showed that dipyridamole in combination with aspirin is superi or to aspirin alone. CONCLUSIONS: Antiplatelet therapy is a key component of secondary preventio n strategies in ischemic stroke. While aspirin has been the cornerstone in the management of stroke, other classes of antiplatelet drugs present new o pportunities to optimize antiplatelet therapy.