Letter by Spence Regarding Article, “Antiplatelet Regimen for Patients With Breakthrough Strokes While on Aspirin: A Systematic Review and Meta-Analysis”
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To the Editor:
There are several issues to be considered besides those mentioned in the review and meta-analysis by Lee et al1 of antiplatelet therapy in patients who have strokes while on aspirin. The authors made the briefest of comments about the key issue in these patients: if a patient has a stroke while on antiplatelet therapy, it is crucial to consider why it happened. In other words, if aspirin did not work, what was the cause of this stroke?
The commonest mistakes I see being made in the emergency department are (1) doubling the dose of aspirin, and (2) switching to clopidogrel. If antiplatelet therapy is indeed indicated, it would be better to add clopidogrel (or better still, …