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(Stroke. 2005;36:2034.)
© 2005 American Heart Association, Inc.

Comments, Opinions, and Reviews

Antiplatelet Agents in Secondary Prevention of Stroke

A Perspective

From the Division of Clinical Neuroscience, St Georges Hospital Medical School, London, UK.

Correspondence to John W. Norris, Division of Clinical Neurosciences, St Georges Hospital Medical School, London SW17 0RE, UK. E-mail j.norris{at}sghms.ac.uk

Background and Purpose— Antiplatelet agents are widely used in the secondary prevention of stroke and other vascular events. The purpose of this review is to give a perspective of the factors involved in clinical practice for selecting antiplatelet drugs appropriate to the patient population.

Summary of Review— Aspirin remains the most popular drug, because it is modestly effective (25% risk reduction); however, it has undesirable side effects that are sometimes serious. The nonaspirin compounds are marginally more effective but are much more expensive and subject to commercial pressures from industry. A completely new look at these compounds is necessary, rather than spending more precious resources on "drug wars" that are expensive in time and money.

Conclusion— A "polypill" has been previously proposed, and possibly a combination of drugs targeted at the major vascular risk factors that is given to patients within 24 hours of initial stroke symptoms and to clearly defined patient populations may prove a solution.

Key Words: antiplatelet agents • stroke management