Stroke Prevention: Antiplatelet and Antithrombolytic Therapy

Serious Adverse Vascular Events Associated With Perioperative Interruption of Antiplatelet and Anticoagulant Therapy

“…Failure of aspirin therapy suggests the need for a dosage increase or concurrent administration of an ADP‐receptor antagonist 29 . Simultaneous delivery of ticlopidine and aspirin, clopidogrel and aspirin, and the veteran antiplatelet agent dipyridamole and aspirin are each superior in efficacy to aspirin alone 30–35 . Of these, the combination of clopidogrel and aspirin may provide the best prophylaxis.…”

Serious Adverse Vascular Events Associated With Perioperative Interruption of Antiplatelet and Anticoagulant Therapy

“…29 Simultaneous delivery of ticlopidine and aspirin, clopidogrel and aspirin, and the veteran antiplatelet agent dipyridamole and aspirin are each superior in efficacy to aspirin alone. [30][31][32][33][34][35] Of these, the combination of clopidogrel and aspirin may provide the best prophylaxis. Randomized controlled trials indicate the safety and efficacy of continuous antiplatelet prophylaxis for atheroembolic stroke recurrence.…”

Recommendations for Stroke Management

“…According to the findings of the Antiplatelet Trialists' Collaboration 159 , the most widely tested were doses between 160 and 325 mg per day, and these doses may be most beneficial. However, there also exists evidence that doses of 30 and 50 mg daily are effective [163][164][165] . It seems that acetylsalicylic acid in any daily dose, 30 mg or higher, leads to moderate but significant reduction of stroke.…”

“…Four trials investigated whether the combination of dipyridamole plus acetylsalicylic acid is superior to acetylsalicylic acid alone and all had negative findings [175][176][177][178] . The European Stroke Prevention Study II 165 analyzed 6602 patients with stroke or TIA who were randomized to acetylsalicylic acid alone (50 mg daily), extended-release dipyridamole alone (400 mg daily), acetylsalicylic acid plus extended-release dipyridamole (50 + 400 mg daily), or placebo. The risk reduction in stroke events in the acetylsalicylic acid plus dipyridamole group (37%) was significantly higher than in either the acetylsalicylic acid group (18.1%) or dipyridamole group (16.3%).…”