Document Detail


Antithrombotic Secondary Prevention After Stroke.
MedLine Citation:
PMID:  11487459     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
In patients with transient ischemic attack (TIA) or ischemic stroke of noncardiac origin, antiplatelet drugs are able to decrease the risk of stroke by 11% to 15%, and decrease the risk of stroke, myocardial infarction (MI), and vascular death by 15% to 22%. Aspirin leads to a moderate but significant reduction of stroke, MI, and vascular death in patients with TIA and ischemic stroke. Low doses are as effective as high doses, but are better tolerated in term of gastrointestinal side effects. The recommended aspirin dose, therefore, is between 50 and 325 mg. Bleeding complications are not dose-dependent, and also occur with the lowest doses. The combination of aspirin (25 mg twice daily) with slow release dipyridamole (200 mg twice daily) is superior compared with aspirin alone for stroke prevention. Ticlopidine is effective in secondary stroke prevention in patients with TIA and stroke. For some endpoints, it is superior to aspirin. Due to its side effect profile (neutropenia, thrombotic thrombocytopenic purpura ), ticlopidine should be given to patients who are intolerant of aspirin. Prospective trials have not indicated whether ticlopidine is suggested for patients who have recurrent cerebrovascular events while on aspirin. Clopidogrel has a better safety profile than ticlopidine. Although not investigated in patients with TIA, clopidogrel should also be effective in these patients assuming the same pathophysiology than in patients with stroke. Clopidogrel is second-line treatment in patients intolerant for aspirin, and first-line treatment for patients with stroke and peripheral arterial disease or MI. A frequent clinical problem is patients who are already on aspirin because of coronary heart disease or a prior cerebral ischemic event, and then suffer a first or recurrent TIA or stroke. No single clinical trial has investigated this problem. Therefore, recommendations are not evidence-based. Possible strategies include the following: continue aspirin, add dipyridamole, add clopidogrel, switch to ticlopidine or clopidogrel, or switch to anticoagulation with an International Normalized Ratio (INR) of 2.0 to 3.0. The combination of low-dose warfarin and aspirin was never studied in the secondary prevention of stroke. In patients with a cardiac source of embolism, anticoagulation is recommended with an INR of 2.0 to 3.0. At the present time, anticoagulation with an INR between 3.0 and 4.5 can not be recommended for patients with noncardiac TIA or stroke. Anticoagulation with an INR between 3.0 and 4.5 carries a high bleeding risk. Whether anticoagulation with lower INR is safe and effective is not yet known. Treatment of vascular risk factors should also be performed in secondary stroke prevention.
Authors:
Hans-Christoph Diener; Peter Ringleb
Related Documents :
10386679 - Emergency physician treatment of acute stroke with recombinant tissue plasminogen activ...
25248659 - Use of the upoint phenotype system in treating chinese patients with chronic prostatiti...
19649749 - Feasibility of nirs in the neurointensive care unit: a pilot study in stroke using phys...
10763789 - Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitat...
16793719 - The relationship between mean platelet volume, stroke subtype and clinical outcome.
12154259 - Prevalence and predictors of upper airway obstruction in the first 24 hours after acute...
23722869 - Endoscopic evaluation of gastrointestinal tract in patients with hereditary hemorrhagic...
3400819 - Does intracranial dye study contribute to evaluation of carotid artery disease?
10235599 - Gastric myoelectrical activity in patients with parkinson's disease: evidence of a prim...
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Current treatment options in neurology     Volume:  3     ISSN:  1534-3138     ISO Abbreviation:  Curr Treat Options Neurol     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-Aug-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815940     Medline TA:  Curr Treat Options Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  451-462     Citation Subset:  -    
Affiliation:
*Department of Neurology, University of Essen, Hufelandstrasse 55, Essen 45122, Germany. h.deiner@uni.essen.de
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Increased Intracerebral Pressure Following Stroke.
Next Document:  Spontaneous Arterial Dissection.