Brain Neurorehabil.  2014 Sep;7(2):76-85. 10.12786/bn.2014.7.2.76.

Pharmacological Secondary Prevention of Ischemic Stroke

• Cho HJ
• Kang TH

• KMID: 1797639
• DOI: http://doi.org/10.12786/bn.2014.7.2.76

Abstract

The causes of ischemic stroke are widely diverse, ranging from large artery atherosclerosis to cardioembolism, and it is important to use preventive therapy toward the goal reducing the future risk of recurrent ischemic stroke, myocardial infarction, and vascular death. Antithrombotic therapy is one of the fundamental medical approaches for secondary prevention of ischemic stroke, which is broadly divided into two general categories, those that exert their effect via platelet inhibition (antiplatelet agents), and those that influence various factors in the clotting cascade (anticoagulants). In general, the clinical guidelines recommend antiplatelet agents for patients with non-cardioembolic stroke, while anticoagulants is indicated for patients with presumed or proven cardioembolic stroke. Many clinical trials have attempted to test the efficacy and safety of antithrombotics in ischemic stroke. This review will discuss on currently available antithrombotic agents that have demonstrated efficacy for secondary prevention of ischemic stroke.

Keyword

antiplatelet agent; anticoagulant; secondary prevention; ischemic stroke

MeSH Terms

Anticoagulants
Arteries
Atherosclerosis
Blood Platelets
Fibrinolytic Agents
Humans
Myocardial Infarction
Platelet Aggregation Inhibitors
Secondary Prevention*
Stroke*
Anticoagulants
Fibrinolytic Agents
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 Platelet activation pathway and actions of antiplatelet agents. AA: arachidonic acid, ADP: adenosine diphosphate, AMP: adenosine monophosphate, COX: cyclooxygenase, GP: glycoprotein, PDE: phosphodiesterase, TP: thromboxane receptor, TXA2: thromboxane A2.

• 

  Fig. 2 Choice of anticoagulants from European society of cardiology guidelines. AF: atrial fibrillation, CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, vascular disease, age 65~74 years, female.

• 

  Fig. 3 Coagulation cascade and actions of new oral anticoagulants. TF: tissue factor.

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