Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke

Abstract

Ischemic stroke represents one of the leading causes of death and disability in both the United States and abroad, particularly for patients with prior ischemic stroke or transient ischemic attack (TIA). A quintessential aspect of secondary stroke prevention is the use of different pharmacological agents, mainly antiplatelets and anticoagulants. Antiplatelets and anticoagulants exhibit their effect by blocking the activation pathways of platelets and the coagulation cascade, respectively. Clinical trials have demonstrated the safety and efficacy of antiplatelets for noncardioembolic stroke prevention, while anticoagulants are more often used for cardioembolic stroke prevention. Commonly used antiplatelets include aspirin, clopidogrel, and aggrenox (aspirin plus extended-release dipyridamole). Furthermore, commonly used anticoagulants include warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban. Each of these drugs has a unique mechanism of action, and they share some common adverse events such as gastrointestinal bleeding and intracranial hemorrhage in more serious cases. Consequently, physicians should carefully assess the benefits and risks of using different antiplatelet or anticoagulant therapies when managing patients with previous ischemic stroke or TIA. This review discuses the published literature on major clinical trials assessing the efficacy of different antiplatelet and anticoagulant drugs under varying circumstances and the subsequent guidelines that have been developed by the American Heart Association/American Stroke Association. Additionally, the role of imaging in stroke prevention is discussed.

Antithrombotic Preventive Medication Prescription Redemption and Socioeconomic Status in Hungary in 2016: A Cross-Sectional Study

“…The number of prescriptions and the number of redeemed prescriptions for specified oral antithrombotic drugs as prime examples of commonly used classes of antithrombotic agents for secondary cardiovascular prevention [ 16 ], such as vitamin K antagonists (a coumarin derivate, acenocoumarol—Syncumar;—all warfarin products available in Hungary), a Factor Xa inhibitor (rivaroxaban—Xarelto), and a platelet aggregation inhibitor (clopidogrel—all originator and generic products available in Hungary), were collected from the National Health Insurance Fund Administration of Hungary for each primary-healthcare practice for the entire year of 2016. According to the Hungarian regulations, general practitioners can prescribe only one type of drug as a 1-month dose of one prescription for patients with long-term medication use.…”

Impact of Edoxaban on Thrombin-Dependent Platelet Aggregation

“…[1][2][3] Currently, 2 pharmacologically different groups of DOACs are used: factor Xa and factor IIa inhibitors. 4 Edoxaban is a selective factor Xa inhibitor. It is as effective as the VKAs with respect to the prevention of stroke or systemic embolism and is associated with significantly lower incidence of bleeding and death from cardiovascular causes.…”

The Marine-Derived Triterpenoid Frondoside A Inhibits Thrombus Formation

“…Thrombus formation is triggered by intravascular blood clotting as a result of hyperaggregability of platelets, increased blood viscosity, and impaired fibrinolysis. Antithrombotic compounds can be divided into two classes, anticoagulants and antiplatelet drugs [1]. Antiplatelet drugs target specific surface proteins, including adenosine diphosphate (ADP) and glycoprotein (GP)IIb/IIIa receptors, as well as intracellular proteins, such as cyclooxygenase [2].…”