Title:Acute Ischemic Cerebrovascular Events on Antiplatelet Therapy: What is the Optimal Prevention Strategy?
Volume: 19
Issue: 21
Author(s): Haralampos Milionis and Patrik Michel
Affiliation:
Keywords:
Ischemic stroke, antiplatelet, aspirin, dipyridamole, clopidogrel, resistance, treatment failure, risk factor, etiology.
Abstract: Even though patients who develop ischemic stroke despite taking antiplatelet drugs represent a considerable proportion of
stroke hospital admissions, there is a paucity of data from investigational studies regarding the most suitable therapeutic intervention.
There have been no clinical trials to test whether increasing the dose or switching antiplatelet agents reduces the risk for subsequent
events. Certain issues have to be considered in patients managed for a first or recurrent stroke while receiving antiplatelet agents. Therapeutic
failure may be due to either poor adherence to treatment, associated co-morbid conditions and diminished antiplatelet effects (resistance
to treatment). A diagnostic work up is warranted to identify the etiology and underlying mechanism of stroke, thereby guiding
further management. Risk factors (including hypertension, dyslipidemia and diabetes) should be treated according to current guidelines.
Aspirin or aspirin plus clopidogrel may be used in the acute and early phase of ischemic stroke, whereas in the long-term, antiplatelet
treatment should be continued with aspirin, aspirin/extended release dipyridamole or clopidogrel monotherapy taking into account tolerance,
safety, adherence and cost issues. Secondary measures to educate patients about stroke, the importance of adherence to medication,
behavioral modification relating to tobacco use, physical activity, alcohol consumption and diet to control excess weight should also be
implemented.
