ANTIPLATELET AGENTS AND SECONDARY STROKE PREVENTION

This review of the literature reports on secondary prevention of ischemic stroke. The aim of secondary prevention is to protect patients who belong to a risk-group from the occurrence of brain infarction. Symptomatic patients with a demonstrated carotid artery stenosis of 70 percent and above, most probably will benefit from carotid endarterectomy if performed by a skilled surgeon in the absence of contraindications. Oral anticoagulant drugs do play a minor role in medical prevention of brain infarction. Antiplatelet drugs, however, are in use for almost two decades and (meta-) analysis of clinical trials points to acetylsalicylic acid (ASA) as a drug with a modest but certain contribution of about 15% in the endpoint reduction, even in lower dosages. The addition of dipyridamole (DP) to the classic ASA dose appears to increase the end-point reduction to 30%. Neither DP nor sulfinpyrazone (SP) as monotherapy have been demonstrated to be efficaceous in the secondary prevention of ischemic stroke. Ticlopidine (TC) seems a promising alternative for ASA in those patients that suffer adverse effects from ASA. TC, however, itself has a number of different side effects that limit its application. New clinical trials are under way in order to improve the efficacy of drug treatment in the secondary prevention of brain infarction.