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VIEWPOINT

Secondary Stroke Prevention With Antiplatelet Therapy With Emphasis on the Cardiac Patient

A Neurologist's View

Jewish Hospital, Louisville, Kentucky

Manuscript received July 20, 2004; revised manuscript received December 22, 2004, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. James M. Gebel, Jr., 250 East Liberty Street, Suite 500, Louisville, Kentucky 40202 (Email: j.gebel{at}att.net).

The prevention of secondary vascular events is of paramount importance in patients with a history of stroke or transient ischemic attack (TIA). Most cardiologists are aware of the benefits of clopidogrel plus aspirin versus those of other antiplatelet regimens in patients with acute coronary syndrome. Using a representative post-stroke patient as an example, this article reviews data evaluating the effectiveness of antiplatelet regimens in preventing secondary vascular events in stroke and TIA patients. These results differ from those seen in clinical trials of acute coronary syndrome patients. Clinical studies provide little evidence that clopidogrel, with or without aspirin, is more efficacious in this setting than aspirin alone. Moreover, the increased risk of bleeding episodes with clopidogrel and aspirin in combination probably outweighs any small reductions in secondary event risk. In contrast, extended-release dipyridamole (ER-DP) plus aspirin reduces secondary stroke risk to a significantly greater extent (23% relative risk reduction) than aspirin alone. Currently available clinical trial data support the use of ER-DP plus aspirin, but not clopidogrel plus aspirin, to prevent secondary vascular events after stroke or TIA.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CI = confidence interval   CVD = cardiovascular disease   ER-DP = extended-release dipyridamole   IR-DP = immediate-release dipyridamole   PAD = peripheral artery disease   RRR = relative risk reduction   TIA = transient ischemic attack

This article has been cited by other articles:

				J. M. Gebel Jr Reply J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2569 - 2570. [Full Text] [PDF]

				H. L. Horton Secondary Stroke Prevention and Antiplatelet Therapy J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2568 - 2568. [Full Text] [PDF]