Oral Antiplatelet Therapy for Secondary Prevention of Non-Cardioembolic Ischemic Cerebrovascular Events

Abstract

Stroke is the leading cause of disability and mortality worldwide. After an acute cerebrovascular ischemia, recurrent vascular events, including recurrent stroke or transient ischemic accidents (TIA), occur in around 20% of cases within the first 3 months. In order to minimize this percentage, antiplatelet therapy may play a key role in the management of non-cardioembolic cerebrovascular events. This review will focus on the current evidence of antiplatelet therapies most commonly discussed in practice guidelines and used in clinical practice for the treatment of stroke/TIA complications. The antiplatelet therapies most commonly used and discussed are as follows: aspirin, clopidogrel, and ticagrelor.

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

“…Among LT candidates, it is frequent to find indications for aspirin with or without P2Y12 inhibitors in bearers of coronary stents or as secondary prevention of noncardioembolic ischemic stroke. 21 , 22 Again, the scientific evidence supporting antiplatelet therapies in patients with advanced liver disease is scarce and their use is considered of high risk, particularly in patients with severe thrombocytopenia.…”

Eficácia e segurança da ponte de tirofiban como alternativa à suspensão da terapia antiplaquetária dupla em pacientes submetidos à cirurgia: uma revisão sistemática

“…Many patients are put on dual antiplatelet therapy (DAPT) with aspirin and P2Y12 receptor inhibitors with the objective of preventing stent thrombosis (ST) and adverse cardiovascular and cerebrovascular events such as death, myocardial infarction (MI), and stroke. 1 - 3 This therapy is employed because the risk of perioperative ST is higher during the first 4 to 6 weeks after placement of both conventional and drug-eluting stents, so guidelines recommend use of DAPT for a minimum of 12 months after cardiac revascularization. 4 Withdrawal of DAPT is a major risk factor for ST, particularly during this period.…”

“…Um grande número de pacientes utiliza a terapia antiplaquetária dupla (TAPD) com ácido acetilsalicílico (AAS) e inibidores do receptor P2Y12 com o intuito de prevenir trombose de stents (TS) e eventos adversos cardiovasculares e cerebrovasculares, como morte, infarto do miocárdio (IM) e acidente vascular cerebral (AVC) 1 - 3 . Isso ocorre porque o risco de TS no período perioperatório, tanto para stents convencionais quanto para farmacológicos, é maior nas primeiras 4 a 6 semanas após o implante, sendo recomendado por diretrizes a utilização da TAPD por, no mínimo, 12 meses após revascularização cardíaca 4 .…”

PAR4 Antagonism in Patients With Coronary Artery Disease Receiving Antiplatelet Therapies

“…1–6 Despite this, atherothrombotic cardiovascular conditions represent a substantial residual burden of morbidity and mortality, and many people remain at major risk of recurrent events. 7–10…”

“…[1][2][3][4][5][6] Despite this, atherothrombotic cardiovascular conditions represent a substantial residual burden of morbidity and mortality, and many people remain at major risk of recurrent events. [7][8][9][10] Aspirin inhibits cyclo-oxygenase 1 to block thromboxane A2 platelet activation, whereas P2Y12 antagonists, such as ticagrelor, block ADP-induced platelet aggregation. Combination antiplatelet therapy with aspirin and a P2Y12 antagonist is used clinically to reduce recurrent coronary events in patients with acute coronary syndrome.…”