The use of dual antiplatelet therapy for ischemic cerebrovascular events

Abstract

In the last 10 years, the use of dual antiplatelet therapy (DAPT) in the neurological ambit has been explored in patients with non-cardioembolic ischemic stroke, transient ischemic attack (TIA), and intracranial atherosclerotic disease. Two clinical trials (CHANCE and POINT) showed that in patients with minor non-cardioembolic ischemic stroke or high-risk TIA, the addition of clopidogrel to aspirin reduces the risk of stroke recurrence. Another trial (THALES) evaluated the association of ticagrelor and aspirin in mild-to-moderate non-cardioembolic ischemic stroke or high-risk TIA, showing a reduced risk of subsequent stroke compared to aspirin alone. Finally, the use of DAPT has been assessed in the treatment of stroke associated with atherosclerotic intracranial stenosis in the SAMMPRIS trial, showing a favorable profile compared to percutaneous angioplasty and stenting. The aim of this article is, after a review the major trials evaluating DAPT in patients with ischemic cerebrovascular events and the ways they have been implemented in Italian, European, and USA guidelines, to provide a practical algorithm to help clinicians in their everyday clinical practice and to outline possible caveats in the practical implementation of guidelines. Possible limitations and gaps in knowledge regarding specific conditions (e.g., the use of DAPT after acute phase therapies) are also underlined.

A Case of Basilar Artery Thrombus Improved With Anticoagulation

“…Patients typically start on antiplatelets if the etiology is presumed to be small vessel disease without atrial fibrillation. If the patient has a transient stroke symptom or NIHSS score of <3, the patient would be on dual therapy for 21 days, followed by monotherapy [7][8][9]. The commonly used antiplatelet drugs are aspirin, clopidogrel, ticagrelor, or cilostazol.…”

In Vivo Experimental Models of Cerebral Ischemia: Analysis, Translational Potential and Clinical Relevance

“…Platelet aggregation and thrombus formation contribute to the formation and worsening of ischemic strokes. Antiplatelet agents, such as clopidogrel, or ticagrelor, inhibit platelet activation and aggregation, reducing the risk of further vascular occlusion [71].…”

Antiplatelet Effects of Flavonoid Aglycones Are Mediated by Activation of Cyclic Nucleotide-Dependent Protein Kinases

“…Cardiovascular diseases and their prevention in subjects at high risk of cardiovascular events remain the main reasons for the administration of antiplatelet therapy [6]. Dual antiplatelet therapy with aspirin and P 2 Y 12 receptor antagonists is standard for patients with acute myocardial infarction and ischemic stroke [7,8]. Nevertheless, the following development of drug resistance, hypersensitivity [9][10][11][12], and serious adverse effects, among which are peptic ulcers, gastrointestinal bleeding, and aspirin-induced asthma, are associated with the application of this therapy [13][14][15][16].…”