Skip to main content
SpringerLink
Log in
Book cover

Stroke Revisited: Diagnosis and Treatment of Ischemic Stroke pp 135–143Cite as

Selections of Antithrombotic Agents During Acute Stage

  • Chapter
  • First Online:

  • 2611 Accesses

Part of the book series: Stroke Revisited ((STROREV))

Abstract

There are two major classes of antithrombotic agents that can be used in acute stroke settings, namely, antiplatelet agents and anticoagulant agents. Aspirin is recommended to use as soon as possible (within 48 h after stroke onset) for acute ischemic stroke patients. Recently, short-term dual antiplatelet therapy (aspirin plus clopidogrel) has been indicated to be safe and superior to aspirin in acute ischemic stroke patients in China. However, the dual antiplatelet therapy with aspirin and clopidogrel is not recommended as stroke prevention for the long term. Early anticoagulation occasionally might be used for certain stroke patients, although it is not recommended in general. Oral anticoagulation is recommended for secondary stroke prevention in patients with cardioembolic stroke. However, the initial timing of anticoagulation in acute stroke setting in cardioembolic stroke patients remains unclear. Further prospective studies to evaluate the safety, efficacy, optimal term, or optimal selections of antithrombotic agents will be needed for the acute ischemic stroke patients, considering the etiology of stroke. Physicians should consider the etiology of stroke (at least, cardioembolic stroke or non-cardioembolic stroke) to select the antithrombotic agents.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e601S–36S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.

    Article  PubMed  Google Scholar 

  3. Zhang Q, Wang C, Zheng M, et al. Aspirin plus clopidogrel as secondary prevention after stroke or transient ischemic attack: a systematic review and meta-analysis. Cerebrovasc Dis. 2015;39:13–22.

    Article  CAS  PubMed  Google Scholar 

  4. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569–81.

    Google Scholar 

  5. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641–9.

    Google Scholar 

  6. Sandercock PA, Counsell C, Tseng MC, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;(3):CD000029.

    Google Scholar 

  7. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–7.

    Article  CAS  PubMed  Google Scholar 

  8. Benavente OR, Hart RG, McClure LA, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012;367:817–25.

    Article  PubMed  Google Scholar 

  9. Kennedy J, Hill MD, Ryckborst KJ, et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 2007;6:961–9.

    Article  CAS  PubMed  Google Scholar 

  10. Wong KS, Chen C, Fu J, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol. 2010;9:489–97.

    Article  CAS  PubMed  Google Scholar 

  11. Markus HS, Droste DW, Kaps M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111:2233–40.

    Article  CAS  PubMed  Google Scholar 

  12. Wang Y, Zhao X, Liu L, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11–9.

    Article  CAS  PubMed  Google Scholar 

  13. Hong KS, Lee SH, Kim EG, et al. Recurrent ischemic lesions after acute atherothrombotic stroke: clopidogrel plus aspirin versus aspirin alone. Stroke. 2016;47:2323–30.

    Article  CAS  PubMed  Google Scholar 

  14. Wang Y, Zhao X, Lin J, et al. Association between CYP2C19 loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack. JAMA. 2016;316:70–8.

    Article  CAS  PubMed  Google Scholar 

  15. Bellemain-Appaix A, Brieger D, Beygui F, et al. New P2Y12 inhibitors versus clopidogrel in percutaneous coronary intervention: a meta-analysis. J Am Coll Cardiol. 2010;56:1542–51.

    Article  CAS  PubMed  Google Scholar 

  16. Johnston SC, Amarenco P, Albers GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med. 2016;375:35–43.

    Article  CAS  PubMed  Google Scholar 

  17. Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359:1238–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Halkes PH, van Gijn J, Kappelle LJ, et al. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367:1665–73.

    Article  CAS  PubMed  Google Scholar 

  19. Dengler R, Diener HC, Schwartz A, et al. Early treatment with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke within 24 h of symptom onset (EARLY trial): a randomised, open-label, blinded-endpoint trial. Lancet Neurol. 2010;9:159–66.

    Article  CAS  PubMed  Google Scholar 

  20. Shinohara Y, Katayama Y, Uchiyama S, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010;9:959–68.

    Article  CAS  PubMed  Google Scholar 

  21. Shimizu H, Tominaga T, Ogawa A, et al. Cilostazol for the prevention of acute progressing stroke: a multicenter, randomized controlled trial. J Stroke Cerebrovasc Dis. 2013;22:449–56.

    Article  PubMed  Google Scholar 

  22. Teruo K, Tucker A, Sugimura T, et al. Ultra-early combination antiplatelet therapy with cilostazol for the prevention of branch atheromatous disease: a multicenter prospective study. Cerebrovasc Dis Extra. 2016;6:84–95.

    Article  Google Scholar 

  23. Kwon SU, Cho YJ, Koo JS, et al. Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke. 2005;36:782–6.

    Article  CAS  PubMed  Google Scholar 

  24. Berge E, Sandercock P. Anticoagulants versus antiplatelet agents for acute ischaemic stroke. Cochrane Database Syst Rev. 2002;(4):CD003242.

    Google Scholar 

  25. Kern R, Nagayama M, Toyoda K, et al. Comparison of the European and Japanese guidelines for the management of ischemic stroke. Cerebrovasc Dis. 2013;35:402–18.

    Article  PubMed  Google Scholar 

  26. Paciaroni M, Agnelli G, Micheli S, et al. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38:423–30.

    Article  CAS  PubMed  Google Scholar 

  27. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–91.

    Article  CAS  PubMed  Google Scholar 

  28. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  CAS  PubMed  Google Scholar 

  29. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.

    Article  CAS  PubMed  Google Scholar 

  30. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093–104.

    Article  CAS  PubMed  Google Scholar 

  31. Arihiro S, Todo K, Koga M, et al. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: the SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016;11:565–74.

    Article  PubMed  Google Scholar 

  32. Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. JAMA. 1998;279:1265–72.

    Google Scholar 

  33. Wong KS, Chen C, Ng PW, et al. Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study. Lancet Neurol. 2007;6:407–13.

    Article  CAS  PubMed  Google Scholar 

  34. Wada T, Yasunaga H, Horiguchi H, et al. Outcomes of argatroban treatment in patients with atherothrombotic stroke: observational nationwide study in Japan. Stroke. 2016;47:471–6.

    Article  CAS  PubMed  Google Scholar 

  35. Hosomi N, Naya T, Kohno M, et al. Efficacy of anti-coagulant treatment with argatroban on cardioembolic stroke. J Neurol. 2007;254:605–12.

    Article  CAS  PubMed  Google Scholar 

  36. Markus HS, Hayter E, Levi C, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14:361–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan

    Tomohisa Nezu M.D., Ph.D., Naohisa Hosomi M.D., Ph.D. & Masayasu Matsumoto M.D., Ph.D.

  2. Japan Community Healthcare Organization (JCHO), Hoshigaoka Medical Center, Hirakata, Japan

    Masayasu Matsumoto M.D., Ph.D.

Authors
  1. Tomohisa Nezu M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naohisa Hosomi M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayasu Matsumoto M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomohisa Nezu M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Neurology, Seoul National University Hospital, Department of Neurology, Seoul, Korea (Republic of)

    Seung-Hoon Lee

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media Singapore

About this chapter

Cite this chapter

Nezu, T., Hosomi, N., Matsumoto, M. (2017). Selections of Antithrombotic Agents During Acute Stage. In: Lee, SH. (eds) Stroke Revisited: Diagnosis and Treatment of Ischemic Stroke. Stroke Revisited. Springer, Singapore. https://doi.org/10.1007/978-981-10-1424-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-1424-6_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-1423-9

  • Online ISBN: 978-981-10-1424-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation