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Worldwide, 15 million people suffer stroke each year from which a third die and a further third sustain severe disability, with ischaemic events accounting for ∼80% of all strokes.1 The annual estimated economic burden of stroke is €64.1 billion in Europe alone.2 While recent major investments in acute stroke services have focused on thrombolysis and hospitalisation in dedicated stroke wards, we believe that primary and secondary stroke prevention should remain of utmost importance in a disease that carries such serious permanent neurological sequelae. Antiplatelet agents such as aspirin, diypridamole or clodpidogrel are pharmacological options that can have a potentially beneficial role in stroke prevention, but healthcare professionals should also take account of several major limitations in the use of these drugs.
One of the major challenges in primary prevention of stroke stems from the need to accurately identify the at-risk group from seemingly healthy participants. We recognise that a proportion of newly diagnosed stroke patients are not users of antiplatelet medication prior to the event,3 and this might imply lack of sensitivity of existing cardiovascular (CV) risk prediction tools in reliably identifying those groups of patients who are most likely to subsequently develop CV adverse events.4 The difficulties here may stem from gaps in risk prediction rules or problems in accurately quantifying the relative contribution of multiple prognostic factors that put patients at a high …