Optimal Antiplatelet Therapy for Secondary Prevention of Ischemic Stroke

By Matthew E. Fink, MD, Louis and Gertrude Feil Professor in Clinical Neurology and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York-Presbyterian Hospital

SOURCE: Kim JT, et al. Different antiplatelet strategies in patients with new ischemic stroke while taking aspirin. Stroke 2016;47:128-134.

After an acute ischemic stroke, patients typically take aspirin regularly to safeguard against CVD. Under these conditions, the ideal antiplatelet therapy to ensure secondary prevention remains unclear.

In order to identify the most effective course of treatment, this study’s authors selected 1172 patients with acute non-cardioembolic stroke who took aspirin for the prevention of cardiovascular disease at the time of onset of stroke from a registry database cataloguing 14 hospitals in South Korea.

These patients were thus divided into three groups according to their treatment regime: 1) those 212 who continuously maintained aspirin monotherapy, 2) those 246 who swapped aspirin for a different antiplatelet agent, and 3) those 714 adding who coupled aspirin treatment with another antiplatelet agent.

The patients were then monitored for a full year before their results were analyzed through a Cox proportional hazards regression analysis. When compared with the aspirin-only group after a year of follow-up, the group that swapped for another antiplatelet agent saw significant drop in their composite vascular event rate.

As such, the study’s findings strongly suggest that substituting aspirin with another antiplatelet and/or coupling aspirin treatment with other antiplatelet treatments may be more effective alternative(s) than aspirin-only treatment when it comes to the prevention and avoidance of subsequent vascular events occurring in patients who had experienced a new ischemic stroke while they were taking aspirin.