This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 39/5/1647    most recent STROKEAHA.107.189063v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Adams, R. J. Articles by Schwamm, L. H. Search for Related Content PubMed PubMed Citation Articles by Adams, R. J. Articles by Schwamm, L. H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID Medline Plus Health Information Blood Thinners Statins Stroke

(Stroke. 2008;39:1647.)
© 2008 American Heart Association, Inc.

AHA/ASA Science Advisory

Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Robert J. Adams, MS, MD, FAHA, Chair; Greg Albers, MD; Mark J. Alberts, MD, FAHA; Oscar Benavente, MD; Karen Furie, MD, MPH, FAHA; Larry B. Goldstein, MD, FAHA, FAAN; Philip Gorelick, MD, MPH, FAHA, FAAN; Jonathan Halperin, MD, FAHA; Robert Harbaugh, MD, FACS, FAHA; S. Claiborne Johnston, MD, PhD; Irene Katzan, MD, MS, FAHA; Margaret Kelly-Hayes, RN, EdD, FAHA; Edgar J. Kenton, MD, FAHA, FAAN; Michael Marks, MD; Ralph L. Sacco, MS, MD, FAHA, FAAN Lee H. Schwamm, MD, FAHA

Key Words: AHA Scientific Statement • stroke • transient ischemic attack

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The American Heart Association/American Stroke Association (AHA/ASA) Writing Committee for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack (TIA) has reviewed the results of recent trials that were published after our previous recommendations were issued.¹ Our intention in the present statement is to provide a brief review of the new data, to update specific recommendations, and to provide the reasons for any modifications. The 2 areas in which major new clinical trials have been published are (1) the use of specific antiplatelet agents for stroke prevention in patients with a history of noncardioembolic ischemic stroke or TIA and (2) the use of statins in the prevention of recurrent stroke.

	Antithrombotic Use for Prevention of Ischemic Stroke in Patients With History of Noncardioembolic Ischemic Stroke

 
Recently published trials have added to the evidence of the benefit of the use of specific antiplatelet agents for stroke prevention in patients with a history of noncardioembolic ischemic stroke or TIA. The secondary prevention guidelines¹ have been updated to reflect this new evidence.

Addition of Clopidogrel to Aspirin for Prevention of Vascular Events
The Clopidogrel and Aspirin Versus Aspirin Alone for the Prevention of Atherothrombotic Events (CHARISMA) trial² was a double-blinded study that randomized 15 603 subjects with cardiovascular disease or multiple risk factors for cardiovascular disease to either clopidogrel 75 mg plus low-dose aspirin (75 to 162 mg) or placebo plus aspirin (75 to 162 mg). Roughly 35% of subjects (n=4320) qualified on the basis of the presence of cerebrovascular disease within 5 years of enrollment; approximately a third experienced TIA. The median follow-up was 28 months.

No significant differences were seen in the rates . . . [Full Text of this Article]

This article has been cited by other articles:

				A. A. Rabinstein Statins Prevent Stroke Recurrences... But Can They Improve Stroke Outcome? Stroke, November 1, 2009; 40(11): 3413 - 3414. [Full Text] [PDF]

				A. Algra Digestion of the Antiplatelets Comparison of PRoFESS: 18-7=1? Stroke, May 1, 2009; 40(5): 1932 - 1935. [Full Text] [PDF]

				J. S. Ross, E. A. Halm, and D. M. Bravata Use of Stroke Secondary Prevention Services: Are There Disparities in Care? Stroke, May 1, 2009; 40(5): 1811 - 1819. [Abstract] [Full Text] [PDF]

				C. S. Roberts, P. B. Gorelick, X. Ye, C. Harley, and G. A. Goldberg Additional Stroke-Related and Non-Stroke-Related Cardiovascular Costs and Hospitalizations in Managed-Care Patients After Ischemic Stroke Stroke, April 1, 2009; 40(4): 1425 - 1432. [Abstract] [Full Text] [PDF]

				R. M. Samuelson, E. I. Levy, A. H. Siddiqui, and L. N. Hopkins The Cost of Stroke Prevention Stroke, February 1, 2009; 40(2): e41 - e42. [Full Text] [PDF]

				R. G. Holloway and C. B. MD When Disclosures Are More Interesting Than the Evidence Stroke, February 1, 2009; 40(2): e44 - e44. [Full Text] [PDF]

				R. Adams Response to Letter by Holloway and Benesch Stroke, February 1, 2009; 40(2): e45 - e45. [Full Text] [PDF]

				H. P. Adams Jr Secondary Prevention of Atherothrombotic Events After Ischemic Stroke Mayo Clin. Proc., January 1, 2009; 84(1): 43 - 51. [Abstract] [Full Text] [PDF]

				H.-C. Diener, H. Mattle, M. Böhm, and F. Ruschitzka CHAPTER 15a The Heart and the Brain ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text]

				L. Mosca Aspirin Chemoprevention: One Size Does Not Fit All Circulation, June 3, 2008; 117(22): 2844 - 2846. [Full Text] [PDF]