Selections of Antithrombotic Agents During Acute Stage

Fig. 12.1

The approach to antithrombotic therapy for acute ischemic stroke patients with non-cardioembolic stroke. * Several guidelines suggest that early anticoagulation is not recommended

Fig. 12.2

The approach to antithrombotic therapy for acute ischemic stroke patients with cardioembolic stroke. * Several guidelines suggest that early anticoagulation is not recommended

Conclusions

Aspirin is recommended to use as soon as possible for acute ischemic stroke patients. The CHANCE trial provided the additional evidence that short-term dual antiplatelet therapy (aspirin plus clopidogrel) was safe and superior to aspirin alone in acute ischemic stroke patients. The Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial is currently enrolling North American patients with inclusion or exclusion criteria similar to CHANCE trial. In addition, the Triple Antiplatelets for Reducing Dependency after Ischemic Stroke (TARDIS) trial which is comparing the safety of triple antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) versus guideline therapy (aspirin and dipyridamole or clopidogrel alone) in 4100 patients with acute stroke or TIA is ongoing. A conclusive determination of the usefulness of the aggressive short-term combination of antithrombotic agents for the secondary prevention of ischemic stroke in acute stroke settings awaits several large randomized trials.

Suggestions from Clinical Practice Guidelines

Aspirin should be administered orally as early as possible after diagnosis of acute ischemic stroke. Initial aspirin dose depends on various situations and is 160–325 mg per day in most countries. Clopidogrel might be effective, but not fully evaluated in acute stroke setting. Usefulness of urgent anticoagulation is not proven in any cases. However, use of clopidogrel or urgent anticoagulation should be based on individual situations.

References

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