Abstract
This review addresses 2 fields: secondary prevention after cerebral ischaemia of cardiac origin (CICO) and that after cerebral ischaemia of arterial origin (CIAO). The major trial after CICO is the EAFT that showed the superiority of mild oral anticoagulation (INR 2-3) over aspirin and placebo. Despite several more recent trials with ximelagatran (e.g. SPORTIF and ACTIVE-W) the current standard remains mild oral anticoagulation. After CIAO several trials tried to improve the 13% relative risk reduction achieved with aspirin. Attempts with oral anticoagulation were disappointing: high INRs were not safe (SPIRIT), low INRs not effective (WARSS) and with a mild regimen (INR 2-3) the benefits for ischaemic events were cancelled by more major bleeding. Clopidogrel tended to be modestly more effective than aspirin after stroke (CAPRIE), but its combination with aspirin appeared not to be safe (MATCH, CHARISMA). Combination of aspirin with dipyridamole, however, was safe and more effective than aspirin alone (ESPS-2, ESPRIT). Recent American and European guidelines mention both the combination of aspirin and dipyridamole and clopidogrel monotherapy for secondary prevention after cerebral ischaemia of arterial origin. The recent PRo- FESS trial found no differences in the efficacy of aspirin plus dipyridamole and clopidogrel, hence there is no need for major adaptation of the guidelines.
Keywords: Secondary prevention, stroke, antithrombotic
Current Vascular Pharmacology
Title: Secondary Stroke Prevention with Antithrombotic Drugs
Volume: 8 Issue: 1
Author(s): Els Lisette Leo Maria De Schryver and Ale Algra
Affiliation:
Keywords: Secondary prevention, stroke, antithrombotic
Abstract: This review addresses 2 fields: secondary prevention after cerebral ischaemia of cardiac origin (CICO) and that after cerebral ischaemia of arterial origin (CIAO). The major trial after CICO is the EAFT that showed the superiority of mild oral anticoagulation (INR 2-3) over aspirin and placebo. Despite several more recent trials with ximelagatran (e.g. SPORTIF and ACTIVE-W) the current standard remains mild oral anticoagulation. After CIAO several trials tried to improve the 13% relative risk reduction achieved with aspirin. Attempts with oral anticoagulation were disappointing: high INRs were not safe (SPIRIT), low INRs not effective (WARSS) and with a mild regimen (INR 2-3) the benefits for ischaemic events were cancelled by more major bleeding. Clopidogrel tended to be modestly more effective than aspirin after stroke (CAPRIE), but its combination with aspirin appeared not to be safe (MATCH, CHARISMA). Combination of aspirin with dipyridamole, however, was safe and more effective than aspirin alone (ESPS-2, ESPRIT). Recent American and European guidelines mention both the combination of aspirin and dipyridamole and clopidogrel monotherapy for secondary prevention after cerebral ischaemia of arterial origin. The recent PRo- FESS trial found no differences in the efficacy of aspirin plus dipyridamole and clopidogrel, hence there is no need for major adaptation of the guidelines.
Export Options
About this article
Cite this article as:
De Schryver Leo Maria Els Lisette and Algra Ale, Secondary Stroke Prevention with Antithrombotic Drugs, Current Vascular Pharmacology 2010; 8 (1) . https://dx.doi.org/10.2174/157016110790226543
DOI https://dx.doi.org/10.2174/157016110790226543 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Ischemic Cardiovascular Diseases: Mechanisms, Diagnosis and Therapy
Ischemic cardiovascular disease includes myocardial infarction, coronary atherosclerotic heart disease, angina pectoris, etc., constitute the leading cause of patient mortality by preventing tissues from getting sufficient oxygen and nutrients. Ischemic heart disease, as a clinical condition, is characterized by myocardial ischemia, causing an imbalance between myocardial blood supply and demand, ...read more
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Lipid-based Nano-phytomedicines for Disease Treatment and Theranostic Applications
Current Nanomedicine PPARγ in Angiogenesis and Vascular Development
Current Angiogenesis (Discontinued) Hydrogen Sulfide and Endothelial Dysfunction: Relationship with Nitric Oxide
Current Medicinal Chemistry Evaluation of Differentiation Quality of Several Differentiation Inducers of Bone Marrow-derived Mesenchymal Stem Cells to Nerve Cells by Assessing Expression of Beta-tubulin 3 Marker: A Systematic Review
Current Stem Cell Research & Therapy Energetic Metabolic Roles in Pulmonary Arterial Hypertension and Right Ventricular Remodeling
Current Pharmaceutical Design Smoking and Atherosclerosis: Mechanisms of Disease and New Therapeutic Approaches
Current Medicinal Chemistry Nanoparticle-Based Tumor Theranostics with Molecular Imaging
Current Pharmaceutical Biotechnology Lymphatics and Inflammation
Current Medicinal Chemistry Influence of Ultrasound Mediated Transdermal Delivery of Losartan Potassium
Drug Delivery Letters Genetic Variability of Matrix Metalloproteinase Genes in Cardiovascular Disease
Current Topics in Medicinal Chemistry Alstrom Syndrome: Genetics and Clinical Overview
Current Genomics Beyond Hemostasis: The Role of Platelets in Inflammation, Malignancy and Infection
Cardiovascular & Hematological Disorders-Drug Targets Impact of Sex Hormone Metabolism on the Vascular Effects of Menopausal Hormone Therapy in Cardiovascular Disease
Current Drug Metabolism Nonalcoholic Fatty Liver Disease and Cardiovascular Disease
Current Pharmaceutical Design Clinical Profile of Relaxin, a Possible New Drug for Human Use
Current Drug Safety Cardiovascular Pharmacogenetics of Antihypertensive and Lipid- Lowering Therapies
Current Molecular Medicine Treatment of Elevated Homocysteine: A Potential Risk Factor for Vascular Disease
Current Medicinal Chemistry - Immunology, Endocrine & Metabolic Agents Treating Heart Failure with Preserved Ejection Fraction Related to Arterial Stiffness. Can we Kill Two Birds With One Stone?
Current Vascular Pharmacology Biology and Clinical Relevance of Mannose-Binding Lectin
Drug Design Reviews - Online (Discontinued) Vascular C-Reactive Protein in the Pathogenesis of Coronary Artery Disease:Role of Vascular Inflammation and Oxidative Stress
Cardiovascular & Hematological Disorders-Drug Targets