Antiplatelet Therapy and Oral Anticoagulation for Prevention of Ischemic Stroke

Purpose of Review: To provide an update on stroke prevention strategies with oral anticoagulants (vitamin K antagonists) and platelet inhibitors. Recent Findings: In asymptomatic women, aspirin reduces the risk of stroke but not of myocardial infarction while in men only the risk of myocardial infarction but not stroke could be significantly reduced. No benefit of oral anticoagulants could be shown in patients with non-cardioembolic stroke. Patients with symptomatic intracranial stenosis had a higher risk of intracerebral bleeding with oral anticoagulation compared to high dose aspirin. The combination of aspirin plus extended-release dipyridamole significantly reduces the risk of recurrent stroke as well as the risk of a combined cardiovascular outcome compared to aspirin alone. The combination of aspirin plus clopidogrel did not reduce the risk of stroke in patients with non-cardioembolic ischemic events compared to clopidogrel monotherapy. Summary: For primary prevention in patients <65 years without risk factors, no antithrombotic treatment should be given. The choice between oral anticoagulants and antiplatelet agents depends on the stroke etiology and individual risk factor profile. Patients with non-cardioembolic stroke generally are candidates for antiplatelet therapy. New anticoagulation strategies will facilitate dosing and may reduce under-use in patients with atrial fibrillation and clear indications for oral anticoagulation.