Antiplatelet Agents for Stroke Prevention Following Transient Ischemic Attack

2008 ◽  
Vol 101 (1) ◽  
pp. 70-78
Author(s):  
Jesse Weinberger
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Antiplatelet Agents ◽  
Ischemic Attack

scholarly journals Antithrombotic Prescription at Discharge in Medicare Patients with Ischemic Stroke/Transient Ischemic Attack: Results from the National Stroke Project

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 376-377
Author(s):  
Timothy F Kresowik ◽  
David S Nilasena ◽  
Anton F Piskac ◽  
Rebecca A Hemann ◽  
Marian A Brenton ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Antiplatelet Agents ◽  
Secondary Stroke Prevention ◽  
Antithrombotic Agents ◽  
Patterns Of Use ◽  
Medicare Patients ◽  
Ischemic Attack ◽  
Univariate Analyses

P205 Background: Antiplatelet agents have been shown to be effective for secondary stroke prevention in patients with ischemic stroke (IS) or transient ischemic attack (TIA). As part of HCFA’s National Stroke Project, we examined patterns of use of antithrombotic agents for inpatients with IS or TIA. Methods: Findings were based on abstracted data from a sample of Medicare inpatient medical records (discharge dates 4/98 - 3/99). All U.S. states, the District of Columbia and Puerto Rico were sampled using a systematic random approach. Each record had a principal diagnosis of one of the following ICD-9-CM codes: 362.34, 433.xx, 434.xx, 435.0, 435.1, 435.3, 435.8, 435.9 or 436. The main outcome measure was the frequency of eligible patients with a prescription or a plan for antithrombotic therapy at discharge. Antithrombotics were aspirin, clopidogrel, dipyridamole, ticlopidine and warfarin. Results: Of the 36,650 cases reviewed, 25,659 met the criteria for inclusion in the indicator. A large percentage of excluded cases (53.1%) were removed due to a history or current finding of hemorrhage. Nationwide, 20,947 (unadjusted rate 81.6%) patients were prescribed an antithrombotic at discharge or had a plan for starting an antithrombotic after discharge. The state-specific rates ranged from 72.0% to 90.1%. Univariate analyses showed this therapy was prescribed less frequently (p<0.001) for adults 85 years and over (rate=77.8%, OR=0.74, 95% CI=0.69–0.80), women (rate=80.4%, OR=0.83, 95% CI=0.78–0.89) and African-Americans (rate=77.6%, OR=0.76, 95% CI=0.68–0.85). Asians were found to have been prescribed this therapy more frequently than other races (p<0.02, rate=87.2%, OR=1.54 95% CI=1.10–2.16). Among those IS/TIA patients who also had atrial fibrillation (AF), 57.1% received warfarin. Conclusions: Antithrombotic agents are not prescribed for almost one-fifth of eligible Medicare inpatients with IS/TIA. For those with IS/TIA and AF, a large proportion are not treated with warfarin. These results show important opportunities for improvement in secondary stroke prevention for Medicare patients.

scholarly journals Antiplatelet Therapy After Noncardioembolic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1812-1818 ◽  
Author(s):  
Jacoba P. Greving ◽  
Hans-Christoph Diener ◽  
Johannes B. Reitsma ◽  
Philip M. Bath ◽  
László Csiba ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Clinical Benefit ◽  
Antiplatelet Agents ◽  
Vascular Events ◽  
Subgroup Analyses ◽  
Ischemic Attack ◽  
Net Clinical Benefit

Background and Purpose— We assessed the efficacy and safety of antiplatelet agents after noncardioembolic stroke or transient ischemic attack and examined how these vary according to patients’ demographic and clinical characteristics. Methods— We did a network meta-analysis (NMA) of data from 6 randomized trials of the effects of commonly prescribed antiplatelet agents in the long-term (≥3 months) secondary prevention of noncardioembolic stroke or transient ischemic attack. Individual patient data from 43 112 patients were pooled and reanalyzed. Main outcomes were serious vascular events (nonfatal stroke, nonfatal myocardial infarction, or vascular death), major bleeding, and net clinical benefit (serious vascular event or major bleeding). Subgroup analyses were done according to age, sex, ethnicity, hypertension, qualifying diagnosis, type of vessel involved (large versus small vessel disease), and time from qualifying event to randomization. Results— Aspirin/dipyridamole combination (RR NMA-adj , 0.83; 95% CI, 0.74–0.94) significantly reduced the risk of vascular events compared with aspirin, as did clopidogrel (RR NMA-adj , 0.88; 95% CI, 0.78–0.98), and aspirin/clopidogrel combination (RR NMA-adj , 0.83; 95% CI, 0.71–0.96). Clopidogrel caused significantly less major bleeding and intracranial hemorrhage than aspirin, aspirin/dipyridamole combination, and aspirin/clopidogrel combination. Aspirin/clopidogrel combination caused significantly more major bleeding than aspirin, aspirin/dipyridamole combination, and clopidogrel. Net clinical benefit was similar for clopidogrel and aspirin/dipyridamole combination (RR NMA-adj , 0.99; 95% CI, 0.93–1.05). Subgroup analyses showed no heterogeneity of treatment effectiveness across prespecified subgroups. The excess risk of major bleeding associated with aspirin/clopidogrel combination compared with clopidogrel alone was higher in patients aged <65 years than it was in patients ≥65 years (RR NMA-adj , 3.9 versus 1.7). Conclusions— Results favor clopidogrel and aspirin/dipyridamole combination for long-term secondary prevention after noncardioembolic stroke or transient ischemic attack, regardless of patient characteristics. Aspirin/clopidogrel combination was associated with a significantly higher risk of major bleeding compared with other antiplatelet regimens.

scholarly journals Antiplatelet therapy in stroke prevention after non-cardioembolic transient ischemic attack

2021 ◽  
Vol 13 (5) ◽  
pp. 14-19
Author(s):  
A. V. Fonyakin ◽  
L. A. Geraskina ◽  
M. Yu. Maksimova
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
Basic Principles ◽  
Advantages And Disadvantages ◽  
Minor Ischemic Stroke ◽  
New Ideas ◽  
Ischemic Attack

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.

scholarly journals Antithrombotic Therapy for Secondary Prevention in Patients with Non-Cardioembolic Stroke or Transient Ischemic Attack: A Systematic Review

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 447
Author(s):  
Dániel Tornyos ◽  
Alexandra Bálint ◽  
Péter Kupó ◽  
Oumaima El Alaoui El Abdallaoui ◽  
András Komócsi
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Randomized Controlled Trials ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
Cochrane Library ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Ischemic Attack

Stroke embodies one of the leading causes of death and disability worldwide. We aimed to provide a comprehensive insight into the effectiveness and safety of antiplatelet agents and anticoagulants in the secondary prevention of ischemic stroke or transient ischemic attack. A systematic search for randomized controlled trials, comparing antiplatelet or anticoagulant therapy versus aspirin or placebo among patients with ischemic stroke or transient ischemic attack, was performed in order to summarize data regarding the different regimens. Keyword-based searches in the MEDLINE, EMBASE, and Cochrane Library databases were conducted until the 1st of January 2021. Our search explored 46 randomized controlled trials involving ten antiplatelet agents, six combinations with aspirin, and four anticoagulant therapies. The review of the literature reflects that antiplatelet therapy improves outcome in patients with ischemic stroke or transient ischemic attack. Monotherapy proved to be an effective and safe choice, especially in patients with a high risk of bleeding. Intensified antiplatelet regimens further improve stroke recurrence; however, bleeding rate increases while mortality remains unaffected. Supplementing the clinical judgment of stroke treatment, assessment of bleeding risk is warranted to identify patients with the highest benefit of treatment intensification.

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