Dual or Mono Antiplatelet Therapy for the Prevention of Ischemic Stroke: A Literature Review

Abstract

Ischemic stroke is defined as a sudden loss of blood to the brain which results in deprivation of oxygen and other nutrients. It can be either a transient episode called as “transient ischemic attack” (TIA), or it could last longer than 24 hours giving rise to “infarction of tissues” in the central nervous system. Anti-platelet agents are widely used for the secondary prophylaxis of ischemic stroke, and amongst them, aspirin remains the drug of choice. In this literature review, we summarized the existing data regarding the ischemic type of strokes with particular attention to the use of antiplatelet agents for this purpose. The following review highlights the significance of the use of dual antiplatelet (aspirin and clopidogrel) regimen for the stroke prevention. The role of dual antiplatelet (aspirin and clopidogrel) in patients with a recent TIA (within 30 days) or severe stenosis (70%–99%) of a major intracranial artery, for 90 days, might be a beneficial approach.

Cerebral Hemodynamic Evaluation After Cerebral Recanalization Therapy for Acute Ischemic Stroke

“…Reduced perfusion impairs the clearance of emboli (48); therefore, aspirin plus clopidogrel as dual antiplatelet therapy may be considered after weighing the benefits and risks of hemorrhage (49). Induced hypertension, to achieve a 10–30% increase in mean arterial pressure, may be warranted.…”

Dual antiplatelet therapy in ischemic stroke

“…Minör inme ve geçici iskemik atak ile gelen hastalarda, ölüm ve bağımlılık oranlarının azaltılması, inme tekrarının azaltılması, vasküler komplikasyonların önlenmesi amacıyla ikili antiagregan tedavilerin, erken dönemde ve kısa süreli kullanımı yaygınlaşmaktadır. Bu konudaki derlemelerin ve yapılan meta-analizlerin sayısı son yıllarda artmıştır (23,33,34). Şu anda en kuvvetli öneri minör inme ve GİA hastalarında, ilk 24 saat içinde başlanarak, 10-21 gün süreyle ikili antiagregan tedavi, klopidogrel ve aspirin birlikte verilmesi, daha sonra tekli ilaç ile devam edilmesidir.…”

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

“…Oral anticoagulation (OAC) reduces the risk of stroke and all-cause mortality compared with control or placebo in patients with non-valvular AF [10,11]. In addition, there is no evidence of better stroke outcomes in patients with AF taking antiplatelet agents versus not taking any antithrombotic medication [12,13]. However, OAC is frequently under-prescribed, especially in the elderly [14], and of those treated, the proportion of adherent patients could be as low as 41% one year later [15][16][17].…”