Antiplatelet Agents for Stroke Prevention

Abstract

Stroke is one of the leading causes of disability and death. Ischemic stroke is a syndrome with heterogeneous mechanisms and multiple etiologies, rather than a singularly defined disease. Approximately one third of ischemic strokes are preceded by another cerebrovascular ischemic event. Stroke survivors are at high risk of vascular events (i.e., cerebrovascular and cardiovascular events), particularly during the first several months after the ischemic event. The use of antiplatelet agents remains the fundamental component of secondary stroke prevention. Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. The use of combination therapy (aspirin plus clopidogrel) has not been proven to be effective or safe to use for prevention of early stroke recurrence or in long-term treatment. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.

High-throughput screening for modulators of ACVR1 transcription: discovery of potential therapeutics for fibrodysplasia ossificans progressiva

“…At the pharmacological level, Dipy acts by different mechanisms. By inhibiting the activity of phosphodiesterases 5 and 3 (PDE5 and PDE3), it increases the intracellular level of cyclic adenosine monophosphate (cAMP), which is a potent inhibitor of platelet activation, and of cyclic guanine monophosphate (cGMP), which has a vasodilator effect on smooth muscle, thus potentiating the platelet inhibitory actions of prostacyclin (PGI2) ( Gresele et al, 2011 ; de Vos-Koppelaar et al, 2014 ; Kim and Liao, 2008 ; Yip and Benavente, 2011 ). Moreover, Dipy inhibits the re-uptake of adenosine by blocking the equilibrative nucleoside transporters (ENTs), thus increasing plasma levels of this nucleoside, which also plays a role in inhibiting platelet aggregation ( Kim and Liao, 2008 ; Visser et al, 2005 ; Dresse et al, 1982 ; German et al, 1989 ), regulation of vascular tone, vasodilation, immunity and inflammation ( Kim and Liao, 2008 ).…”

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

“…344 The combination of aspirin plus clopidogrel for long-term secondary prevention of stroke or other vascular events for 18 months is associated with an increase in life-threatening bleeding with respect to aspirin alone (2.6% vs. 1.3%). 354 Recently, the data safety monitoring board of the Secondary a Patients already taking aspirin at the time of their TIA are assumed to have less risk reduction than a patient starting aspirin de novo -we will apply the data from the '3-6 months' row.…”

Combination Aspirin and Clopidogrel for Secondary Prevention of Ischemic Stroke

“…Lacunar strokes account for approximately 50 % of subjects enrolled in antiplatelet secondary prevention trials and antiplatelet monotherapy is effective for secondary prevention in this population. However, classification of strokes due to small vessel disease in these trials was vaguely defined without neuroimaging confirmation in most cases [24]. In addition, the mechanism of antiplatelet therapy for stroke prevention in this stroke subtype is not completely elucidated.…”