Antiplatelet medication6/13/2023 ![]() ![]() The 2014 AHA/ASA guidelines for prevention of recurrent stroke provide comprehensive recommendations for reducing the risk of recurrent stroke that are beyond the scope of this article. Ticagrelor showed no additional benefit and is not preferred over aspirin for acute treatment of stroke, although it may be a reasonable alternative in patients who are unable to use aspirin. ![]() For patients with minor stroke or high-risk TIA, the guidelines also strongly recommend the use of 21 days of DAPT with aspirin and clopidogrel started within 24 hours of presentation. Aspirin is not advised as a substitute for thrombolytics or mechanical thrombectomy in patients who are eligible for these therapies. If oral administration is not possible, rectal or nasogastric administration is appropriate. 9 Cited trials investigated doses of 160 mg to 300 mg. The 2019 American Heart Association/American Stroke Association (AHA/ASA) guidelines, which focus on early management of ischemic stroke, strongly recommend the administration of aspirin within 24 to 48 hours of acute ischemic stroke (AIS). 8 This article will briefly review the guidelines and antiplatelet medications related to reducing the risk of noncardioembolic ischemic stroke. ![]() 6,7 However, evidence exists that a short course of DAPT immediately following a minor ischemic stroke or high-risk transient ischemic attack (TIA) can provide benefit that outweighs risk in patients with acute minor ischemic stroke or high-risk TIA. 2-5 Single antiplatelet therapy is generally preferred over dual antiplatelet therapy (DAPT) because DAPT results in increased bleeding, which outweighs any benefit. Antiplatelets are preferred over anticoagulants for this indication because of their association with lower rates of intracranial hemorrhage and slightly lower overall mortality rates. Aspirin, clopidogrel, and aspirin/extended-release dipyridamole (ER-DP) are the most commonly used agents. 2 Guidelines for secondary prevention of ischemic stroke recommend a variety of antiplatelet medications. 1 Antiplatelet therapy reduces the risk of recurrent ischemic stroke, particularly those that are of noncardioembolic origin, and is the treatment of choice. 1 Each year, more than 795,000 people in the United States experience a stroke, 87% of which are ischemic. Stroke is a leading cause of death and disability. Although single antiplatelet therapy is the standard for stroke prevention, some data suggest that short courses of dual antiplatelet therapy in selected patients may provide additional protection against recurrent stroke. Aspirin, clopidogrel, and aspirin/extended-release dipyridamole are the most commonly used agents. The American Heart Association/American Stroke Association and the American College of Chest Physicians have published guidelines that provide recommendations on antiplatelet therapy for secondary prevention of ischemic stroke. ABSTRACT: Antiplatelet therapy has been shown to reduce the risk of recurrent stroke in patients who have already experienced a noncardioembolic ischemic stroke or transient ischemic attack. ![]()
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