Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack

Naqvi, Imama; Kamal, Ayeesha Kamran; Rehman, Hasan

doi:10.1002/14651858.cd009716.pub2

Cited by 21 publications

(24 citation statements)

References 104 publications

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“…However, for very large (≥ 2 cm) or giant (≥ 2.5 cm) ruptured or unruptured intracranial aneurysms treated with endovascular reconstruction, ischemic complication rates rise considerably to 15–19%, with an overall complication rate of 30–34% [ 10 ]. In addition, stent-assisted coil embolization typically requires administration of dual antiplatelet therapy for 3–6 months, which is associated with an increased rate of major and minor intracranial and extracranial bleeding events [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neuroform Atlas) self-expanding stents. Although dual antiplatelet therapy is recommended by the manufacturer of PulseRider, prolonged dual antiplatelet therapy increases risk of intracranial and extracranial hemorrhage compared to single agent antiplatelet therapy [ 11 ]. Limited case reports and series have reported use of PulseRider or pCONus HPC in the setting of subarachnoid hemorrhage with the hypothesis that dual antiplatelet therapy may be deferred based on the low metal coverage of these devices [ 16 – 18 ], although long-term data in larger series is not yet available.…”

Section: Discussionmentioning

confidence: 99%

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Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Narsinh¹,

Caton²,

Mahmood

et al. 2021

Interdisciplinary Neurosurgery

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Large, wide-necked basilar apex aneurysms are difficult to treat. Microsurgical clipping can result in neurologic morbidity and mortality. Endovascular treatment often leaves remnants that need retreatment and/or stent placement with dual antiplatelet therapy. The Woven EndoBridge (WEB) is an intrasaccular flow disruption device that can be used without dual antiplatelet therapy. However, the WEB cannot typically be used in large or giant aneurysms > 10 mm because the largest diameter device is the 11 × 9.6 mm single layer sphere (SLS). We present a case in which we use a PulseRider aneurysm neck reconstruction device in the basilar artery to assist in WEB deployment within a 22 mm basilar apex aneurysm with 14 mm neck, thereby permitting aspirin monotherapy postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Narsinh¹,

Caton²,

Mahmood

et al. 2021

Interdisciplinary Neurosurgery

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“…Aspirin, clopidogrel, dipyridamole/aspirin, cilostazol and ticagrelor are commonly used antiplatelet agents. In recent years, numerous randomised controlled trials (RCTs), Cochrane systematic reviews and meta-analyses evaluated the efficacy and safety of antiplatelet therapy for secondary stroke prevention 3–9. Due to the complexity of stroke aetiology and diverse mechanisms of antiplatelet agents (figure 1), it is essential to select optimal antiplatelet therapy in the real-world practice.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the complexity of stroke aetiology and diverse mechanisms of antiplatelet agents (figure 1), it is essential to select optimal antiplatelet therapy in the real-world practice. In this narrative review, we aimed to highlight current evidence and recommendations of the antiplatelet therapy for secondary stroke prevention 2–10…”

Section: Introductionmentioning

confidence: 99%

Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines

Shah

Liu

2022

Stroke Vasc Neurol

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Antiplatelet therapy is one of the mainstays for secondary stroke prevention. This narrative review aimed to highlight the current evidence and recommendations of antiplatelet therapy for stroke prevention.We conducted advanced literature search for antiplatelet therapy. Landmark studies and randomised controlled trials evaluating antiplatelet therapy for secondary stroke prevention are reviewed. Results from Cochrane systematic review, pooled data analysis and meta-analysis are discussed.Single-antiplatelet therapy (SAPT) with aspirin, aspirin/extended-release dipyridamole or clopidogrel reduces the risk of recurrent ischaemic stroke in patients with non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA). Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or ticagrelor for 21–30 days is more effective than SAPT in patients with minor acute noncardioembolic ischaemic stroke or high-risk TIA. Prolonged use of DAPT is associated with higher risk of haemorrhage without reduction in stroke recurrence than SAPT. Compared with placebo, aspirin reduces the relative risk of recurrent stroke by approximately 22%. Aspirin/dipyridamole and cilostazol are superior to aspirin but associated with significant side effects. Cilostazol or ticagrelor might be more effective than aspirin or clopidogrel in patients with intracranial stenosis.SAPT is indicated for secondary stroke prevention in patients with non-cardioembolic ischaemic stroke or TIA. DAPT with aspirin and clopidogrel or ticagrelor for 21–30 days followed by SAPT is recommended for patients with minor acute noncardioembolic stroke or high-risk TIA. Selection of appropriate antiplatelet therapy should also be based on compliance, drug tolerance or resistance.

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“…Антитромбоцитарная терапия является ключевой составляющей для больных, перенесших ишемический инсульт или ТИА, при этом выбор препарата осуществляют с учетом этиологического разнообразия основных факторов внутрисосудистого или внутрисердечного тромбообразования [12]. С целью профилактики повторного инсульта у пациентов, перенесших некардиоэмболический инсульт либо ТИА, был изучен широкий спектр антитромбоцитарных препаратов, в том числе в различных сочетаниях [13]. Н е о т л о ж н а я к о м б и н и р о в а н н а я т е р а п и я т р о м б о ц и т а р н ы м и а н т и а г р е г а н т а м и п о с л е Т И А / и ш е м и ч е с к о г о и н с у л ьт а Попытки найти обоснование для двойной антитромбоцитарной терапии в профилактике повторного некардиоэмболического инсульта -по аналогии с терапией при остром коронарном синдроме -нашли воплощение в продолжении подобных исследований.…”

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

Fonyakin

Гераскина

Maksimova

2021

RJTAO

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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.

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Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack

Cited by 21 publications

References 104 publications

Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines

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

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