Secondary prevention of stroke with antiplatelet drugs

Patients suffering from a transient ischemic attack (TIA) or ischemic stroke are at high risk of a recurrent stroke. The risk is between 10% and 15% in the 1st year after the event and highest in the immediate period following the index event. In patients without cardiac source of embolism, the risk of stroke can be reduced by acetylsalicylic acid (ASA). The relative risk reduction for recurrent vascular events (myocardial infarction, stroke, vascular death) with aspirin is 18% and the risk reduction for stroke 13%. Clopidogrel is superior to ASA in patients with high risk of recurrence due to concomitant vascular disease or multiple risk factors. Clinical trials for secondary stroke prevention at present focus on combination antiplatelet therapy. Large clinical trials such as MATCH, CARESS, CHARISMA, and PKoFESS will investigate whether combination antiplatelet therapy is superior to monotherapy and whether the combination of dipyridamole plus ASA is comparable to clopidogrel plus ASA in terms of efficacy and safety.