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Approaches to preventing recurrent stroke by antithrombocytic therapy are shown to be as diverse as its causes. The diagnosis of cardioembolic stroke in patients with atrial fibrillation should not limit the choice of an antithrombocytic agent to only oral (indirect) anticoagulants (OAC). If OAC cannot be used, antithrombocytic therapy, including combined (clopidogrel + ASA) one, may be considered as a reasonable alternative. Approaches to choosing the optimal antithrombocytic drug in noncardioembolic strokes are intricate since atherosclerosis is a systemic vascular disease and the poststroke period is characterized by a higher risk for not only recurrent stroke, but also for coronary catastrophes. It is concluded that an antithrombocytic agent should be chosen, by taking into account the multifocality of atherosclerosis, associated clinical conditions, diabetes mellitus, intravascular interventions and the individual risk of all cardiovascular events.

About the Authors

A. V. Fonyakin
Neurology Research Center, Russian Academy of Medical Sciences
Russian Federation

L. A. Geraskina
Neurology Research Center, Russian Academy of Medical Sciences
Russian Federation


1. <div><p>Инсульт: диагностика, лечение, профилактика. Под ред. З.А. Суслиной., М.А. Пирадова. М.: МЕДпресс-информ, 2008;288 с.</p><p>Скворцова В.И., Чазова И.Е., Стаховская Л.В. Вторичная профилактика инсульта. М.: ПАГРИ, 2002;120 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 atrial fibrillation investigators. The efficacy of aspirin in patients with atrial fibrillation: analysis of pooled data from 3 randomized trials. Arch Intern Med 1997;157:1237-40.</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>Connolly S., Progue J., Hart R. et al. ACTIVE writing group of the ACTIVE investi- gators. 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>Ворлоу Ч.П., Деннис М.С., ван Гейн Ж. и др. Инсульт. Практическое руководство для ведения больных. СПб., 1998.</p><p>Антитромботическая терапия у больных со стабильными проявлениями атеротромбоза. Российские рекомендации. Кардиоваск тер и профилактика 2009;8 (прилож 6). 20 с.</p><p>Steg G., Bhatt D.L., Wilson P.W.F. et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007;297:1197-206.</p><p>Панченко Е.П., по поручению участников регистра REACH в РФ. Результаты трехлетнего наблюдения за амбулаторными больными с клиническими проявлениями атеротромбоза (анализ российской популяции регистра REACH). Кардиология 2009;10:9-15.</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>Суслина З.А., Танашян М.М., Ионова В.Г. Гемостаз, гемореология и атромбогенная активность сосудистой стенки при ишемических нарушениях мозгового кровообращения. В кн.: Очерки ангионеврологии. Под ред. З.А. Суслиной. М.: Атмосфера, 2005; с. 130-41.</p><p>Gent M., Blakely J.A., Easton J.D. et al. The Canadian American Ticlopidin Study (CATS) in thromboembolic stroke. Lancet 1989;1:1215-20.</p><p>Hass W.K., Easton J.D., Adams H.P. et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients: Ticlopidin aspirin stroke study group. N Engl J Med 1989;321:501-7.</p><p>Gorelick P.B., Richardson D., Kelly M. et al., for the African American Antiplatelet Stroke Prevention Study Investigators. Aspirin and ticlopidine for prevention of recurrent stroke in black patients (AAASPS): a randomized trial. JAMA 2003;289:2947-57.</p><p>Суслина З.А., Танашян М.М., Домашенко М.А. Антитромботическая терапия ишемических нарушений мозгового кровообращения. М.: Медицинское информационное агентство, 2009;224 с.</p><p>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>Bousser M.-G., Eschwegw E.,Haguenau M. et al. «AICLA» controlled trial of aspirin and dipyridamole in the secondary pre- vention of athero-thrombotic cerebral ischemia. Stroke 1983;14:5-14.</p><p>Guiraud-Chaumeil B., Rascol A., David J. et al. Prevention of recurrences of cerebral ischemic vascular accidents by platelet antiaggregants: results of a 30year controlled thera- peutic trial. Rev Neurol (Paris) 1982;138:367-85.</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>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>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></div><br />


For citations:

Fonyakin A.V., Geraskina L.A. ANTITHROMBOCYTIC THERAPY IN THE SECONDARY PREVENTION OF ISCHEMIC STROKE. Neurology, Neuropsychiatry, Psychosomatics. 2009;1(3-4):58-63. (In Russ.)

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