Skip to main content
Log in

Antiplatelet therapy in secondary stroke prevention

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

This article focuses on recent data about the safety and effectiveness of antiplatelet therapies for secondary stroke prevention. Highlights include a discussion of changes in the professional labeling for aspirin and the results of a low- versus high-dose aspirin trial (Aspirin after Carotid Endarterectomy trial). Safety issues regarding aspirin also are considered. Other topics include a review of recent data on thrombotic thrombocytopenic purpura (TTP) associated with ticlopidine and a brief update on clopidogrel. A summary of discussions related to the European Stroke Prevention Study 2 data and Food and Drug Administration consideration of combination dipyridamole/aspirin therapy are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Smith NM, Pathansali R, Bath PM: Platelets and stroke. Vasc Med 1999, 4(3):165–172.

    PubMed  Google Scholar 

  2. Food and Drug Administration: Internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use: final rule for professional labeling of aspirin, buffered aspirin, and aspirin in combination with antacid drug products. Federal Register October 23, 1998, 63(205):56802–56819.

    Google Scholar 

  3. Fields WS, Lemak NA, Frankowski RF, Hardy RJ: Controlled trial of aspirin in cerebral ischemia. Stroke 1977, 8(3):301–316.

    PubMed  CAS  Google Scholar 

  4. Fields WS, Lemak NA, Frankowski RF, Hardy RJ: Controlled trial of aspirin in cerebral ischemia. part II: surgical group. Stroke 1978, 9(4):309–318.

    PubMed  CAS  Google Scholar 

  5. The SALT Collaborative Group: Swedish Aspirin Low-Dose Trial (SALT) of 75 mg Aspirin as Secondary Prophylaxis after Cere-brovascular Ischaemic Events. Lancet 1991, 338:1345–1349.

    Article  Google Scholar 

  6. The Dutch TIA Trial Study Group. A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Eng J Med 1991, 325:1261–1266.

    Article  Google Scholar 

  7. ISIS-2 (Second International Study of Infarct Survival) Collabora-tive Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988, 2:349–360.

    Google Scholar 

  8. Antiplatelet Trialists: Collaboration secondary prevention of vascular disease by prolonged antiplatelet treatment. BMJ 1988, 296:320–331.

    Google Scholar 

  9. UK TIA Study Group, A United Kingdom Transient Ischaemic Attack (UK-TIA) Aspirin Trial: interim results. BMJ 1988, 296:316–320.

    Google Scholar 

  10. Johnson ES, Lanes SF, Wentworth CE III, et al.: Metaregression analysis of the dose-response effect of aspirin on stroke. Arch Intern Med 1999, 159:1248–1253.

    Article  PubMed  CAS  Google Scholar 

  11. Bousser MG, Eschwege E, Haguenau M, et al.: ‘AICLA’ Controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombtic cerebral ischemia. Stroke 1983, 14(1):5–14.

    PubMed  CAS  Google Scholar 

  12. Taylor DW, Barnett HJ, Haynes RB, et al.: Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomized controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 1999 June 26, 353(9171):2179–2184.

    Article  PubMed  CAS  Google Scholar 

  13. Van Gijn J: Low dose aspirin in stroke prevention (Letter). Lancet 1999 June 26, 353(9171):2172–2173.

    Article  PubMed  Google Scholar 

  14. Petty GW, Brown RD Jr., Whisnant JP, et al.: Frequency of major complications of aspirin, warfarin, and intravenous heparin for secondary stroke prevention: a population based study. Ann Intern Med 1999, 130:14–22.

    PubMed  CAS  Google Scholar 

  15. He J, Whelton PK, Vu B, Klag MJ: Aspirin and risk of hemorrhage stroke: a meta-analysis of randomized controlled trial. JAMA 1998, 280:1930–1935.

    Article  PubMed  CAS  Google Scholar 

  16. Boysen G: Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit-risk analysis. J Intern Med 1999, 246:239–245.

    Article  PubMed  CAS  Google Scholar 

  17. Hass WK, Easton JD, Adams HP, et al.: A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med 1989, 321(8):501–507.

    Article  PubMed  CAS  Google Scholar 

  18. Gent M, Blakely JA, Easton JD, et al.: The Canadian American ticlopidine study (CATS) in thromboembolic stroke. Lancet 1989, I:1215–1220.

    Article  Google Scholar 

  19. Gorelick PB, Leurgans SL, Richardson D, et al.: African American Antiplatelet Stroke Prevention Study (AAASPS): clinical trial design. J Stroke Cerebrovasc Dis 1998, 7(6):426–434.

    Article  PubMed  CAS  Google Scholar 

  20. Svenson CK: Representation of American blacks in clinical trials of new drugs. JAMA 1989, 29:415–421.

    Google Scholar 

  21. Chen DK, Kim JS, Sutton DMC: Thrombotic thrombocytopenic purpura associated with ticlopidine use: a report of 3 cases and review of the literature. Arch Intern Med 8 February 1999, 159:311–314.

    Article  PubMed  CAS  Google Scholar 

  22. Bennett CL, Weinberg PD, Rozenberg-Ben-Dror K, et al.: Thrombotic thrombocytopenic purpura associated with ticlopidine. A review of 60 cases. Ann Intern Med 1998, 128(7):541–544.

    PubMed  CAS  Google Scholar 

  23. Ticlopidine revised package insert: Roche Laboratories. 2 June, 1998.

  24. North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991, 325(7):445–453.

    Article  Google Scholar 

  25. Barnett HJ, Taylor DW, Eliasziw M, et al.: Benefit of carotid end-arterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterec-tomy Trial Collaborators. N Engl J Med 1998, 339(20):1415–1425.

    Article  PubMed  CAS  Google Scholar 

  26. Wysowski DK, Bacsanyi J: Blood dyscrasias and hematologic reactions in ticlopidine users (Letter). JAMA 1996, 276(12):952.

    Article  Google Scholar 

  27. Barnett HJM, Eliasziw M, Meldrum HE: Drugs and surgery in the prevention of ischemic stroke. N Engl J Med 1995, 332:238–248.

    Article  PubMed  CAS  Google Scholar 

  28. Shear NH, Appel C: Prevention of ischemic stroke (Letter). N Engl J Med 1995, 333:460.

    Article  PubMed  CAS  Google Scholar 

  29. Barnett HJM, Eliasziw M, Meldrum HE: Prevention of ischemic stroke — Reply (Letter). N Engl J Med 1995, 333:460.

    Article  Google Scholar 

  30. US Department of Health and Human Services: Public Health Service; Food and Drug Administration — Center for Drug Evaluation and Research. Clopidogrel bisulfate [Application #020839]. The Electronic Orange Book. Last Updated: September 07, 1999.

  31. Gorelick PB, Born GVR, D’Agostino RB, et al.: Therapeutic benefit: aspirin revisited in light of the introduction of clopidogrel. Stroke 1999, 30:1716–1721.

    PubMed  CAS  Google Scholar 

  32. FDA press release. Aggrenox™ (Dipyridamole/aspirin) capsule[Original Application #020884]. 15 June 1999.

  33. Open Public Hearing of the Peripheral and Central Nervous System Advisory Committee: Issue: Safety and Efficacy of Aggrenox™ (Dipyridamole/aspirin) capsule [NDA 20-884]. Wednesday April 28, 1999.

  34. Diener HC, et al.: A European Stroke Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neuro Sci 1996, 143:1–13.

    Article  CAS  Google Scholar 

  35. Sivenius J, Cunha L, Diener H-C, et al.: Second European Stroke Prevention Study: antiplatelet therapy effective regardless of age. Acta Neurol Scand 1999, 99:54–60.

    Article  PubMed  CAS  Google Scholar 

  36. Sivenius J, Cunha L, Diener HC, et al.: Antiplatelet treatment does not reduce the severity of subsequent stroke. European Stroke Prevention Study 2 Working Group. Neurology 1999, 53(4):825–829.

    PubMed  CAS  Google Scholar 

  37. Wilterdink JL, Easton JD: Dipyridamole plus aspirin in cerebrovascular disease. Arch Neurol 1999, 56(9):1087–1092.

    Article  PubMed  CAS  Google Scholar 

  38. Herman AG: Rationale for the combination of anti-aggregating drugs. Thromb Res 1998, 92:S17-S21.

    Article  PubMed  CAS  Google Scholar 

  39. Akyuz A, Bolayir E, Dener S, et al.: The effect of aspirin, ticlopidine and their low-dose combination on platelet aggregability in acute ischemic stroke: a short duration follow-up study. Eur J Neurol 1999, 6(1):57–61.

    Article  PubMed  CAS  Google Scholar 

  40. Farrell TP, Hayes KB, Sobel BE, Schneider DJ: The lack of augmentation by aspirin of platelet reactivity by ticlopidine. Am J Cardiol 1999, 83:770–774.

    Article  PubMed  CAS  Google Scholar 

  41. Steinhubl SR, Topol EJ: Clopidogrel with aspirin is the optimal antiplatelet regimen for intracoronary stenting. J Thromb 1999, 7(3):227–231.

    Article  CAS  Google Scholar 

  42. Harker LA, Marsec UM, Kelly AB, et al.: Clopidogrel inhibits stent, graft, and vascular thrombogenesis with antithrombotic enhancement by aspirin in nonhuman primates. Circulation 1998, 98(22):2461–2469.

    PubMed  CAS  Google Scholar 

  43. The PURSUIT Trial Investigators: Inhibition of Platelet glycoprotein IIb/IIIa with Eptifibatide in patients with acute coronary syndromes. N Engl J Med 1998, 339:436–443.

    Article  Google Scholar 

  44. Zhao XQ, Theroux P, Snapinn SM, Sax FL: Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non-Q-wave myocardial infarction: angiographic results from the PRISM-PLUS trial. Circulation 1999, 100(15):1609–1615.

    PubMed  CAS  Google Scholar 

  45. Kereiakes DJ: Oral blockade of the platelet glycoprotein IIb/IIIa receptor: fact or fancy? Am Heart J 1999, 138:S39-S46.

    Article  PubMed  CAS  Google Scholar 

  46. Madan M, Berkowitz SD: Understanding thrombocytopenia and antigenicity with glycoprotein IIb-IIIa inhibitors. Am Heart J 1999, 138(4 Pt 2):317–326.

    Article  PubMed  CAS  Google Scholar 

  47. Blankenship JC: Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors. Am Heart J 1999, 138(4 Pt 2):287–296.

    Article  PubMed  CAS  Google Scholar 

  48. Orgogozo JM: Piracetam in the treatment of acute stroke. Pharmacopsychiat 1999, 32(Supplement):25–32.

    Article  CAS  Google Scholar 

  49. Coto V, Oliviero U, Cocozza M, Milani M: Long-term safety and efficacy of Picotamide, a dual-action antithromboxane agent, in diabetic patients with carotid atherosclerosis: a 6 year follow-up study. J Int Med Res 1998, 26:200–205.

    PubMed  CAS  Google Scholar 

  50. Cesarone MR, Laurora G, DeSanctis MT, et al.: Effect of Triflusal on arteriosclerosis progression assessed with high-resolution arterial ultrasound. Angiology 1999, 50(6):455–463.

    Article  PubMed  CAS  Google Scholar 

  51. Yasue H, Ogawa H, Tanaka H, et al.: Effect of aspirin and trapidil on cardiovascular events after acute myocardial infarction. Am J Cardiol 1999, 83:1308–1313.

    Article  PubMed  CAS  Google Scholar 

  52. Albers GW, Easton JD, Sacco RL, Teal P: Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 1998, 114:683S-698S.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Worrall, B.B., Johnston, K.C. Antiplatelet therapy in secondary stroke prevention. Curr Atheroscler Rep 2, 104–109 (2000). https://doi.org/10.1007/s11883-000-0103-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-000-0103-3

Keywords

Navigation