Published Online
on March 27, 2008

A more recent version of this article appeared on May 1, 2008

This Article Full Text (PDF) CME: Take the course for this article: Stroke: May 2008, Volume 39, Number 5 Correction (v39,pe147) All Versions of this Article: 39/5/1638    most recent STROKEAHA.107.497271v1 Alert me when this article is cited Alert me if a correction is posted 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 O'Donnell, M. J. Articles by Eikelboom, J. W. Search for Related Content PubMed PubMed Citation Articles by O'Donnell, M. J. Articles by Eikelboom, J. W. Pubmed/NCBI databases Medline Plus Health Information Blood Thinners Stroke Related Collections Secondary prevention Acute Cerebral Infarction Antiplatelets Platelets

Submitted on June 22, 2007
Revised on September 20, 2007
Accepted on September 26, 2007

Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke. A Critical Review

Martin J. O'Donnell MB^*; Graeme J. Hankey MD, FRACP; and John W. Eikelboom MB, BS, MSc

From McMaster University (M.J.O., J.W.E.), Hamilton, ON, Canada; and the School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Perth, Australia.

^* To whom correspondence should be addressed. E-mail: odonnm{at}mcmaster.ca.

Abstract—For patients with ischemic stroke or transient ischemic attack caused by atherothromboembolism, immediate and long-term aspirin reduces the relative risk of recurrent stroke, MI, and death attributable to vascular causes. Oral anticoagulation is not more effective than aspirin. Long-term clopidogrel reduces the relative risk of stroke, MI, or vascular death by about 9% (0.3% to 16.5%) compared with aspirin. Any long-term benefits of clopidogrel combined with aspirin, compared with aspirin or clopidogrel alone, appear to be offset by increased major bleeding. The combination of aspirin and extended-release dipyridamole reduces the relative odds of stroke, MI, or vascular death by about 18% (odds ratio 0.82, 0.74 to 0.91) compared with aspirin alone without causing more bleeding. Cilostazole reduces the risk of stroke, MI, or vascular death by 39% compared to placebo. A large clinical trial comparing clopidogrel with the combination of aspirin and dipyridamole, in >20 000 patients with recent (<120 days) atherothrombotic ischemic stroke, is expected to report in 2008. Emerging antiplatelet therapies presently being evaluated for secondary prevention of atherothromboembolism include other P₂Y₁₂ ADP receptor antagonists (prasugrel, cangrelor, AZD 6140), thromboxane receptor antagonists (eg, S18886 - terutroban), and thrombin receptor (PAR-1) antagonists (eg, SCH530348).

Key words: antiplatelet drugs • aspirin • therapy • Clopidogrel

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