Secondary prevention of ischaemic stroke: Antiplatelet drugs and heparin

Treatment with antiplatelet drugs reduces stroke risk by 20 to 30% in patients with TIA or previous stroke. All doses of aspirin are equally effective. Lower doses should therefore be preferred. Gastrointestinal side effects of aspirin increase with dose, whereas severe bleeding complications do not. The combination of two antiplatelet drugs (aspirin plus dipyridamole) is more effective than aspirin alone. Ticlopidine and clopidogrel are two other new antiplatelet drugs for the prevention of stroke, myocardial infarction and Vascular death. Early secondary prevention with aspirin is only marginaly beneficial. Heparin reduces the number of early stroke recurrences while at the same time increasing the risk of cerebral haemorrhage.