Antiplatelet therapy in secondary stroke prevention

2000 ◽  
Vol 2 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Bradford B. Worrall ◽  
Karen C. Johnston
Keyword(s):  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Secondary Stroke Prevention

Abstract 159: Trends in Dual Antiplatelet Therapy Prescription Patterns for Secondary Prevention in Patients With Noncardioembolic Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Peter Shrader ◽  
Eric Smith ◽  
Gregg C Fonarow ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Patient Characteristics ◽  
Minor Stroke ◽  
Secondary Stroke Prevention ◽  
Class Iii ◽  
Prescription Patterns ◽  
Class Iib ◽  
Over Time

Background: The recommendations for dual antiplatelet (DAPT aspirin + clopidogrel) for secondary stroke prevention has evolved over time. Following the publication of CHANCE trial (07/2013), the AHA/ASA updated the DAPT recommendations from Class III harm (10/2010) for patient with noncardioembolic ischemic stroke, to Class IIb benefit ≥ risk (02/2014), and Class IIa benefit >> risk (03/2018) for a subgroup of patients with minor stroke (NIHSS≤3). Subsequent to the last guideline update, the POINT trial (05/2018) provided further support for the effectiveness of DAPT. Methods: We evaluated antiplatelet prescription patterns of 1,024,074 noncardioembolic ischemic stroke survivors (median age 65 years and 46% women) eligible for antiplatelet therapy (no contraindications) and discharged from the Get With The Guidelines-Stroke Hospitals between Q1 2011 and Q1 2019. Results: Baseline patient characteristics were similar within the four periods: pre-CHANCE (01/2011-07/2013), pre-2014 guideline update (08/2013-02/2014), pre-POINT/2018 guideline update (03/2014-05/2018), and post-POINT (06/2018-03/2019). Use of DAPT gradually increased from 16.7% in the pre-CHANCE period, to 19.4% pre-2014 guideline update, 23.3% pre-POINT/2018 guideline update, and 29.8% post-POINT period (p<0.001, Figure). Yet increase in DAPT use was observed over time for individuals with NIHSS≤3 (17.1%, 19.9%, 24.1%, and 31.4%, p<0.001) and those with NIHSS>3 (18.7%, 22.8%, 28.3%, and 28.3%, p<0.001). Conclusions: A sustained increase in DAPT use for secondary stroke prevention was observed after publication of pivotal trials and AHA guideline updates. While recommended for minor strokes or TIA only, such increase was also observed in ischemic stroke patients with NIHSS>3, where the risk-benefit ratio of DAPT remains to be established.

scholarly journals Recurrent Hemorrhagic Transformation of Cardioembolic Stroke in an Elderly Patient: A Case Report and Literature Review

2021 ◽  
Vol 8 (05) ◽  
pp. 01-07
Author(s):  
Wengui Yu
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Anticoagulation Therapy ◽  
Hemorrhagic Transformation ◽  
Cardioembolic Stroke ◽  
Current Evidence ◽  
Amyloid Angiopathy ◽  
Secondary Stroke Prevention

Proper therapy for secondary stroke prevention is crucial in the management of cardioembolic stroke. Although oral anticoagulants were the superior strategy for patients with atrial fibrillation and stroke per current evidence, many patients with cardioembolic stroke were prescribed with antiplatelet therapy due to concern for the risk of bleeding from anticoagulation therapy. We presented a case of an 84-years-old male patient who had sudden-onset left hemiparesis from cardioembolic stroke. Past medical history was significant for paroxysmal atrial fibrillation, hypertension and uncontrolled diabetes. Severe white matter hyperintensity (WMH) was identified with the brain imaging. The local hospital initiated antiplatelet therapy with Aspirin 100 mg daily for secondary stroke prevention. Subsequently he was found to have recurrent asymptomatic hemorrhagic transformation involving each of the infarctions. The case report highlighted that severe WMH and possible cerebral amyloid angiopathy could be a risk factor of hemorrhagic transformation and antiplatelet therapy should be used prudently in such condition.

scholarly journals Antiplatelet therapy in secondary stroke prevention - state of the art

2010 ◽  
Vol 14 (11) ◽  
pp. 2552-2560 ◽  
Author(s):  
Hans-Christoph Diener ◽  
Christian Weimar ◽  
Ralph Weber
Keyword(s):  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
State Of The Art ◽  
Secondary Stroke Prevention

Combination Antiplatelet Therapy for Secondary Stroke Prevention: Enhanced Efficacy or Double Trouble?

2009 ◽  
Vol 103 (8) ◽  
pp. 1107-1112 ◽  
Author(s):  
M. Haris U. Usman ◽  
Lawrence A. Notaro ◽  
Rangadham Nagarakanti ◽  
Eric Brahin ◽  
Scott Dessain ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Secondary Stroke Prevention
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