ANTITHROMBOTIC THERAPY IN THE PREVENTION OF RECURRENT ISCHEMIC STROKE
https://doi.org/10.14412/2074-2711-2009-37
Abstract
The paper gives the current views of the role of antithrombotic therapy in the prevention of recurrent ischemic strokes and describes on-going trials of new antithrombotic agents. It is demonstrated that this treatment should be performed in all patients with ischemic disorders in the brain circulation. Long-term therapy with oral anticoagulants is reasonable in cardioembolic stroke caused by atrial fibrillation and a number of other disorders. Therapy with thrombocytic antiaggregants is more advisable in noncardioembolic stroke
About the Author
A. V. Fonyakin
Neurology Research Center, Russian Academy of Medical Sciences
Russian Federation
Moscow
Russian Federation
Moscow
References
1. <div><p>Суслина З.А., Танашян М.М., Домашенко М.А. Антитромботическая терапия ишемических нарушений мозгового кровообращения. М.: ООО «Медицинское информационное агентство», 2009; 224 с.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke 2006; 37:577-617.</p><p>The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attacks 2008. Cerebrovasc Dis 2008; 25:457-507.</p><p>Bousser M.-G. Antithrombotic agents in the prevention of ischemic stroke. Cerebrovasc Dis 2009; 27(Suppl. 3):12-9.</p><p>The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group. A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. Ann Neurol 1997; 42:857-65.</p><p>Mohr J.P., Thompson J.L.P., Lazar R.M. et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001; 345:1444-51.</p><p>Chimowitz M.I., Lynn M.J., Howlett-</p><p>Smith H. et al. Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators: Comparison of Warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352:1305-16.</p><p>ESPRIT Study Group: Medium intensity oral anticoagulants versus aspirin after cerebral ischemia of arterial origin: a randomized controlled trial. Lancet Neurol 2007; 6:115-24.</p><p>Becker D.M., Segal J., Vaidya D. et al. Sex differences in platelet reactivity and response to low-dose aspirin therapy. JAMA 2006; 295: 1420-7.</p><p>Matias-Guiu J., Ferro J.M., Alvarez-Sabin J. et al. Comparison of triflusal and aspirin for prevention of vascular events in patients after cerebral infarction. The TACIP study: a ran- domized, double-blind, multicenter trial. Stroke 2003; 34:840-8.</p><p>Costa J., Ferro J.M., Matias-Guiu J. et al. Trifluzal for preventing serious vascular events in people at high risk. Stroke 2006; 37; 2193-5.</p><p>Huang Y., Cheng Y., Wu J. et al. Cilostazol as an alternative to aspirin after ischaemic stroke: a randomized double blind pilot study. Lancet Neurol 2008; 7:494-9.</p><p>Shinohara Y., Nishimaru K., Sawada T. et al. Sarpogrelate-aspirin comparative clinical study for efficacy and safety in secondary prevention of cerebral infarction (C-ACCES). Stroke 2008; 39:1827-33.</p><p>Bousser M.-G., Amarenco P., Chamorro A. et al. Rationale and design of a random- ized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin with Terutroban in Patients with a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM) Study Cerebrovasc Dis 2009; 27:509-18.</p><p>Bhatt D.L., Scheiman J., Abraham N.S. et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation 2008; 118:1894-09.</p><p>Adams R.J., Albers G., Alberts M.J. et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and TIA. Stroke 2008; 39:1647-52. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996; 348:1329-39.</p><p>The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) Trial Investigators. Effect of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345:494-502.</p><p>Bhatt D.L., Fox K.A.A., Hacke W. et al. CHARISMA investigators: Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354:1706-17.</p><p>Bhatt D.L., Flather M.D., Hacke W. et al. Patients with prior myocardial infarction, stroke or symptomatic peripheral arterial dis- ease in the CHARISMA trial. J Am Coll Cardiol 2007; 49:1982-8.</p><p>Diener H.C., Bogousslavsky J., Brass L.M. et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomized, double- blind, placebo-controlled trial. Lancet 2004; 364:331-7.</p><p>Kennedy J., Hill M.D., Ryckborst K. et al. FASTER investigators. Fast assessment of stroke and transient ischemic attack to prevent early recurrence (FASTER): a randomized controlled pilot trial. Lancet Neurol 2007; 6:961-9.</p><p>Diener H.C., Cunha L., Forbes C. et al. European Stroke Prevention Study 2. Dipyridaml and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143:1 - 13.</p><p>The ESPRIT study group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischemia of arterial origin (ESPRIT): randomized controlled trial. Lancet 2006; 367:1665-73.</p><p>Diener H.C., Sacco R.L., Yusuf S. Steering Committee of PROFESS Study Group: Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two Antithrombotic regimen (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with stroke. The Prevention Regimen for Effectively Avoiding Second Strokes Trial (PROFESS). Cerebrovasc Dis 2007; 23:368-80.</p><p>Furberg C.D., Psaty B.M., Manolio T.A. et al. Prevalence of atrial fibrillation in eldery subjects (the Cardiovascular Health Study). Am J Cardiol 1994; 74:236-41.</p><p>Hart R.G., Pearce L.A., Aguilar M.I. Meta-analysis: Antithrombotic therapy to prevent strokes in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146:857-67.</p><p>EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342:1255-62.</p><p>Mant J., Hobbs F.D., Fletcher K. et al. BAFTA investigators. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (The Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomized controlled trial. Lancet 2007; 370:493-503.</p><p>Connolly S., Progue J., Hart R. et al. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with Irbesartan for prevention of vascular events (ACTIVE W): a randomized controlled trial. Lancet 2006; 367:1903-12.</p><p>Connolly S., Progue J., Hart R. et al. The ACTIVE Investigators: Effect of clopidogrel added to aspirin in patients with atrial fibrillation (ACTIVE A). New Engl J Med 2009; 360:2066-78.</p><p>Samsa G.P., Matchar D.B., Goldstein L.B. et al. Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med 2000; 160:967-73.</p><p>Alkins P.T., Feldman H.A., Zoble R.G. et al. Secondary stroke prevention with ximelagatran versus warfarin in patients with atrial fibrillation pooled analysis of SPORTIF III and V clinical trials. Stroke 2007; 38:874-80.</p><p>The AMADEUS investigators: Comparison of idraparin with vitamin K antagonists for prevention of thromboem- bolism in patients with atrial fibrillation: a randomized, open-label, noninferiority trial. Lancet 2008; 371:315-21.</p><p>Ezekowitz M.D., Reilly P.A., Nehmiz G. et al. Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO study). Am J Cardiol 2007; 100:1419-26.</p><p>Fuster V., Ryden L.E., Cannom D.S. et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation 2006; 114: 700-52.</p><p>Orgera M.A., O'Malley P.G., Taylor A.J. Secondary prevention of cerebral ischemia in patent foramen ovale: systematic review and meta-analysis. South Med J 2001; 94:699-703.</p><p>Homma S., Sacco R.L., Di Tullio M.R. et al. PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale. Circulation 2002; 105:2625-31.</p><p>Shireman T.I., Howard P.A., Kresowik T.F. et al. Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients. Stroke 2004; 35:2362-7.</p><p>Toyoda K., Yasaka M., Iwade K. et al. Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease. A prospective, multicenter, observational study. Stroke 2008; 39:1740-5.</p><p>Hallas J., Dall M., Andries A. et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population-based case-control study. BMJ 2006; 333:726-8.</p><p>Lip G.Y.N. Don't add aspirin for associat- ed stable vascular disease in a patient with atrial fibrillation receiving anticoagulation. BMJ 2008; 336:614-5.</p></div><br />
Review
For citations:
Fonyakin A.V. ANTITHROMBOTIC THERAPY IN THE PREVENTION OF RECURRENT ISCHEMIC STROKE. Neurology, Neuropsychiatry, Psychosomatics. 2009;1(2):42-47. (In Russ.) https://doi.org/10.14412/2074-2711-2009-37
Views: 831
Email this article 