In secondary (non-afib) stroke prevention, current guidelines recommend antiplatelet therapy (guideline) but do not give a prefence to which type. In the first head to head trial, the RCT PRoFESS Trial (abstract), randomized 20,332 patients to clopidogrel or ASA-dipyridamole within 4 months of an ischemic stroke. There was no significant difference in recurrent stroke, MI, or death between the groups. This study indicates there is not much difference in efficacy between them, and an accompanying editorial satirically states, in haiku “For stroke prevention / use an antiplatelet drug. / Treat hypertension.” (editorial).
In this large multicenter trial, patients with minor stroke or TIA were randomized to clopidogrel+ASA or ASA alone; 90-day stroke occurred in 8% vs 12% respectively, and rates of hemorrhage or hemorrhagic stroke were the same (abstract).
These guidelines provide an evidence based for the use of periprocedural antithrombotics in patients with cerebrovascular disease. They recommend continuing ASA-warfarin for dental procedures, and most other minor procedures. There is little evidence to support the use of procedural bridging with heparin, and it does increase the risk of bleeding. Cessation of therapy for 7 […]
A large analysis from a stroke registry found better outcomes with earlier thrombolytics for acute ischemic stroke; every 15 minutes earlier was associated with an odds ratio of 0.96 for in-hospital death or intracranial hemorrhage, and an odds ratio of 1.03 for being discharged home and 1.04 for walking independently at discharge (abstract).