Ticagrelor showed no additional benefit and is not preferred over aspirin for acute treatment of stroke, although it may be a reasonable alternative in patients who are unable to use aspirin.
For patients with minor stroke or high-risk TIA, the guidelines also strongly recommend the use of 21 days of DAPT with aspirin and clopidogrel started within 24 hours of presentation. Aspirin is not advised as a substitute for thrombolytics or mechanical thrombectomy in patients who are eligible for these therapies. If oral administration is not possible, rectal or nasogastric administration is appropriate. 9 Cited trials investigated doses of 160 mg to 300 mg. The 2019 American Heart Association/American Stroke Association (AHA/ASA) guidelines, which focus on early management of ischemic stroke, strongly recommend the administration of aspirin within 24 to 48 hours of acute ischemic stroke (AIS). 8 This article will briefly review the guidelines and antiplatelet medications related to reducing the risk of noncardioembolic ischemic stroke. 6,7 However, evidence exists that a short course of DAPT immediately following a minor ischemic stroke or high-risk transient ischemic attack (TIA) can provide benefit that outweighs risk in patients with acute minor ischemic stroke or high-risk TIA. 2-5 Single antiplatelet therapy is generally preferred over dual antiplatelet therapy (DAPT) because DAPT results in increased bleeding, which outweighs any benefit. Antiplatelets are preferred over anticoagulants for this indication because of their association with lower rates of intracranial hemorrhage and slightly lower overall mortality rates. Aspirin, clopidogrel, and aspirin/extended-release dipyridamole (ER-DP) are the most commonly used agents. 2 Guidelines for secondary prevention of ischemic stroke recommend a variety of antiplatelet medications. 1 Antiplatelet therapy reduces the risk of recurrent ischemic stroke, particularly those that are of noncardioembolic origin, and is the treatment of choice.
1 Each year, more than 795,000 people in the United States experience a stroke, 87% of which are ischemic. Stroke is a leading cause of death and disability. Although single antiplatelet therapy is the standard for stroke prevention, some data suggest that short courses of dual antiplatelet therapy in selected patients may provide additional protection against recurrent stroke. Aspirin, clopidogrel, and aspirin/extended-release dipyridamole are the most commonly used agents. The American Heart Association/American Stroke Association and the American College of Chest Physicians have published guidelines that provide recommendations on antiplatelet therapy for secondary prevention of ischemic stroke. Also known as blood thinners, these drugs are especially risky for older people who are vulnerable to head injuries from falls, increasing the risk of bleeding in and around the brain.ABSTRACT: Antiplatelet therapy has been shown to reduce the risk of recurrent stroke in patients who have already experienced a noncardioembolic ischemic stroke or transient ischemic attack. However, some people develop serious bleeding problems while taking those medications. Most people with afib take anti-clotting medications that help prevent these strokes. These clots can escape the heart and travel to the brain, blocking blood flow and causing an ischemic stroke. This ear-shaped sac is called the left atrial appendage (LAA).Ībout 90% of blood clots in the heart form in the LAA. When that happens, blood tends to pool - and possibly form clots - in a small pouch that protrudes from the top of the left atrium. During a bout of afib, the heart’s upper chambers (atria) suddenly start to quiver ineffectually. More than five million Americans have atrial fibrillation, a heart rhythm disorder commonly known as afib. Procedures that block or remove the source of dangerous blood clots in the heart may be an option for growing numbers of people.
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