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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 11/2022

13-10-2022 | Ticagrelor | Stroke (B. Ovbiagele, Section Editor)

Navigating Antiplatelet Treatment Options for Stroke: Evidence-Based and Pragmatic Strategies

Authors: Bayan Moustafa, Fernando D. Testai

Published in: Current Neurology and Neuroscience Reports | Issue 11/2022

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Abstract

Purpose of Review

The benefit of using antiplatelet monotherapy in acute ischemic stroke and secondary stroke prevention is well established. In the last few years, several large randomized trials showed that the use of short-term dual antiplatelet therapy in particular stroke subtypes may reduce the risk of recurrent ischemic events. The aim of this article is to provide a critical analysis of the current evidence and recommendations for the use of antiplatelet agents for stroke prevention.

Recent Findings

Long-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for secondary stroke prevention in patients with noncardioembolic ischemic stroke. Short-term dual antiplatelet therapy with aspirin and clopidogrel is superior to antiplatelet monotherapy in secondary stroke prevention when used in patients with mild noncardioembolic stroke or high-risk transient ischemic attack. Dual therapy, however, is associated with an increased risk of major bleeding, particularly when the treatment is extended for greater than 30 days. Similarly, aspirin plus ticagrelor is superior to aspirin monotherapy for the prevention of recurrent ischemic stroke, although this combination is associated with a higher risk of hemorrhagic complications when compared to other dual antiplatelet regimens. Among patients who carry CYP2C19 genetic polymorphisms associated with a slow bioactivation of clopidogrel, short-term treatment with aspirin plus ticagrelor is superior to aspirin plus clopidogrel for the reduction of recurrent stroke; however, the use of ticagrelor is associated with a higher risk of any bleeding. In patients with symptomatic intracranial stenosis, aggressive medical management in addition to dual antiplatelet therapy up to 90 days is recommended.

Summary

Antiplatelet therapy has an essential role in the management of ischemic stroke. The specific antiplatelet regimen should be individualized based on the stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications.
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Metadata
Title
Navigating Antiplatelet Treatment Options for Stroke: Evidence-Based and Pragmatic Strategies
Authors
Bayan Moustafa
Fernando D. Testai
Publication date
13-10-2022
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 11/2022
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-022-01237-z

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