ISSUE 1457
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Recent guidelines from the American Heart Association and American Stroke Association reviewed antithrombotic therapy options for secondary prevention of stroke in patients who have had a stroke or transient ischemic attack (TIA).1
ASPIRIN — Aspirin monotherapy has been shown to reduce the risk of secondary stroke by about 15%. In doses ≤325 mg/day, the annual risk of serious gastrointestinal hemorrhage is about 0.4%, which is 2.5 times the risk without aspirin.2
DIPYRIDAMOLE PLUS ASPIRIN — The antiplatelet drug dipyridamole (Persantine, and generics) is available in combination with aspirin (Aggrenox, and generics). A randomized, controlled trial (ESPRIT) in 2739 patients who had a TIA or minor stroke in the previous 6 months found that a combination of extended-release dipyridamole (200 mg bid)
... more- WN Kernan et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2014; 45:2160.
- SM Weisman and DY Graham. Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med 2002; 162:2197.
- ESPRIT Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 2006; 367:1665.
- RL Sacco et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008; 359:1238.
- HC Diener et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, doubleblind, placebo-controlled trial. Lancet 2004; 364:331.
- Y Wang et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369:11.
- EL De Schryver et al. Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin. Cochrane Database Syst Rev 2012; 9:CD001342.
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