Background: Stroke is a feared vascular event among healthy people and those
with cardiovascular disease, and holds a leading position as a cause of disability and death
worldwide. Antiplatelet therapy is central in the management of patients with ischemic nonembolic
stroke and transient ischemic attacks. Methods: In this narrative review, we provide
an overview and update of evidence regarding antiplatelet treatment in the primary and secondary
prevention of stroke. Results: Aspirin, clopidogrel and aspirin plus dipyridamole are
the mainstays of antiplatelet treatment post-stroke, while promising agents include triflusal,
cilostazol and ticagrelor. Available data are in favor of dual antiplatelet treatment in the early
treatment of atherosclerotic large vessel disease. Long-term dual antiplatelet treatment
should be individualized keeping in mind the higher rates of bleeding complications.
Conclusion: Treatment with an antiplatelet agent is recommended to reduce recurrent
stroke and death in patients with a non-cardioembolic ischemic stroke or transient
ischemic attack. Moreover, clinicians should carefully assess the pros and cons in each case and individualize the
need for prolonged dual antiplatelet therapy.
Keywords: Antiplatelet treatment, dual therapy, ischemic stroke, transient ischemic attack, prevention, recurrence.
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