Antiplatelet Therapy for Secondary Prevention in Stroke - Making the Right Choice

In 2004, approximately 9 million people worldwide experienced a stroke, with the majority being ischemic in nature. While the prognosis for recovery can be good, long-term survival and functional outcome can be improved. Stroke survivors are at an increased risk for recurrent stroke and other ischemic vascular events and face significant cross-risk for atherothrombotic conditions affecting the coronary and peripheral vascular beds. As such, the secondary prevention of ischemic events in patients with stroke has focused on the treatment of atherosclerosis as a whole, with antiplatelet therapy playing a key role. There is some controversy regarding optimal antiplatelet therapy following stroke. The appropriate use of specific agents, the impact of stroke type and proper dosing, and other questions stem from an incomplete understanding of the issues, variability in clinical trial data, diversity in patient demographics, and differences in antiplatelet regimens. This review evaluates the clinical evidence for antiplatelet therapy in patients that have suffered an ischemic stroke, with an emphasis on balancing the benefits of a particular antiplatelet regimen with its attendant risk profile. The critical assessment of emerging trial data and its impact on existing treatment guidelines may aid in choosing the most appropriate antiplatelet regimen for comprehensive secondary prevention following stroke.