Aspirin Should Be First-Line Antiplatelet Therapy in the Secondary Prevention of Stroke
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Long-term management after an ischemic stroke (or transient ischemic attack [TIA]) boils down to reducing not just the high risk of a stroke but also the risk of other serious events due to similar underlying vascular pathology, such as myocardial infarction (MI) and sudden cardiac death.1 Therefore, minimizing causal vascular risk factors (blood pressure, cholesterol, smoking, and diabetes) and lifestyle modification (diet, exercise) are crucial, along with carotid endarterectomy for a few carefully selected patients. But what about doing something about the blood, such as antithrombotic therapy?
A vast amount of randomized data supports the use of antiplatelet drugs to prevent serious vascular events (stroke, MI, and vascular death) in a wide range of patients at high vascular risk (eg, stroke survivors, MI survivors, claudicants). This has been summarized recently by the Antithrombotic Trialists’ collaboration.2 The bottom line is that antiplatelet drugs reduce the odds of such an event by 22%. The effect is more or less identical in patients who have only had a stroke or TIA or if aspirin alone, which makes up two thirds of the data, is considered. Aspirin alone after stroke/TIA reduces the odds of a serious vascular event by 17%.3 Antiplatelet drugs reduce the risk of not only the composite outcome of stroke, MI, and vascular death but also of each of the 3 components separately, more so for nonfatal than fatal events. Undoubtedly, aspirin works in the secondary prevention of stroke. Furthermore, the cost is …