Antithrombotic medication for stroke prevention

Abstract

This article provides the reader with an overview and an update on antithrombotic stroke-prevention strategies. Relevant journals were hand-searched by the authors to compile a broad, but not comprehensive, summary of innovative and clinically relevant studies. These findings were then summarized to provide an expert opinion on selected fields of medical stroke prevention. We conclude that aspirin, clopidogrel or dipyridamol–aspirin are the cornerstone therapies in patients with noncardioembolic stroke. More potent antiplatelet drugs or the combination of aspirin and clopidogrel prevent more ischemic events but also lead to more bleeding complications. For secondary stroke prevention in patients with atrial fibrillation, oral anticoagulation is more effective than aspirin or the combination of aspirin and clopidogrel.

Keywords::

• anticoagulation
• antiplatelet
• ischemic stroke
• primary prevention
• secondary prevention
• transient ischemic attack

Financial & competing interests disclosure

Christian Weimar has received honoraria for participation in clinical trials and contribution to advisory boards or oral presentations from Böhringer Ingelheim, Bristol-Myers Squib, Daiichi Asubio, Novartis, Novo-Nordisk, Sanofi-Aventis. Christian Weimar has no ownership interest and does not own stocks of any pharmaceutical company exceeding €10,000.

Hans-Christoph Diener received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from Abbott, AstraZeneca, Bayer Vital, BMS, Böhringer Ingelheim, CoAxia, D-Pharm, Fresenius, GlaxoSmithKline, Janssen Cilag, MSD, MindFrame, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Servier, Solvay, Thrombogenics, Wyeth, Yamaguchi. Financial support for research projects was provided by Astra/Zeneca, GlaxoSmithKline, Böhringer Ingelheim, Novartis, Janssen-Cilag, Sanofi-Aventis. The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, NIH, Bertelsmann Foundation and Heinz-Nixdorf Foundation. Hans-Christoph Diener has no ownership interest and does not own stocks of any pharmaceutical company.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.