Antiplatelets in secondary stroke prevention: should clopidogrel be the first choice?
- 1Department of Medicine for the Elderly, Lincoln County Hospital, Lincoln, UK
- 2Division of Geriatric Medicine, Nottingham University, Nottingham, UK
- Correspondence to Dr Darren Aw, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK;
Contributors DA wrote the manuscript with critical input and revisions from JCS.
- Received 15 April 2011
- Accepted 6 November 2011
- Published Online First 25 November 2011
Antiplatelet therapy has proven efficacy in the secondary prevention of recurrent non-cardioembolic ischaemic stroke. Recent evidence suggests clopidogrel is as effective as combined therapy with aspirin and extended-release dipyridamole for the prevention of recurrent stroke. As cerebrovascular and ischaemic heart disease are closely related, it would be sensible to use a drug shown to prevent vascular events in both territories. Clopidogrel meets these criteria, is superior to aspirin monotherapy, and has fewer side effects compared with extended-release dipyridamole. While there is no direct evidence supporting the use of clopidogrel in transient ischaemic attacks, it is likely that clopidogrel is effective because transient ischaemic attacks and stroke are part of the same disease spectrum. Clopidogrel could thus be useful as first line secondary prevention therapy in all non-cardioembolic stroke subtypes and transient ischaemic attacks, to prevent recurrent ischaemic events in all vascular territories.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.