Author + information
- Received April 7, 2019
- Revision received June 11, 2019
- Accepted June 24, 2019
- Published online August 5, 2019.
- Victor J. Del Brutto, MDa,∗ (, )@vdelbrutto,
- Seemant Chaturvedi, MDb,
- Hans-Christoph Diener, MD, PhDc,
- Jose G. Romano, MDa and
- Ralph L. Sacco, MD, MSa,∗∗ (, )@DrSaccoNeuro
- aDepartment of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
- bDepartment of Neurology, University of Maryland, Baltimore, Maryland
- cInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
• 23% of all ischemic strokes are recurrent events.
• Antithrombotic agents are part of a comprehensive risk factor management strategy to prevent stroke recurrence.
• Contemporary trials guide management in common stroke causes. However, data for less common stroke etiologies are limited.
• Ongoing trials aim to clarify the efficacy of novel pharmacological approaches to reduce stroke recurrence.
Stroke survivors carry a high risk of recurrence. Antithrombotic medications are paramount for secondary prevention and thus crucial to reduce the overall stroke burden. Appropriate antithrombotic agent selection should be based on the best understanding of the physiopathological mechanism that led to the initial ischemic injury. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis and endothelial injury, whereas anticoagulant agents are favored for cardiogenic embolism and highly thrombophilic conditions. Large randomized controlled trials have provided new data to support recommendations for the evidence-based use of antiplatelet agents and anticoagulant agents after stroke. In this review, the authors cover recent trials that have altered clinical practice, cite systematic reviews and meta-analyses, review evidence-based recommendations based on older landmark trials, and indicate where there are still evidence-gaps and new trials being conducted.
Dr. Chaturvedi has received grant support from Boehringer Ingelheim. Dr. Diener has received honoraria for participation in clinical trials, contribution to Advisory Boards, or oral presentations from Abbott, Achelios, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, Merck Sharp & Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo Nordisk, Paion, Parke-Davis, Pfizer, Portola, Sanofi, Schering Plough, Servier, Solvay, St. Jude, Syngis, Talecris, Thrombogenics, WebMD Global, and Wyeth; has received financial support for research projects from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi, Syngis, and Talecris; has served as editor of Neurology International Open, Aktuelle Neurologie, and Arzneimitteltherapie, as coeditor of Cephalalgia, and on the editorial board of Lancet Neurology, Current Neurology and Neuroscience Reports, European Neurology, and Cerebrovascular Disorders; and has served as chair of the Treatment Guidelines Committee of the German Society of Neurology and contributed to the EHRA and ESC guidelines for the treatment of AF. Dr. Romano receives salary support (to the Department of Neurology at the University of Miami) from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke Multiple Program Director/Principal Investigator (PD/PI) Award (1R01NS084288). Dr. Sacco has received institutional grant support from the NIH, the American Heart Association, and Boehringer Ingelheim. Dr. Del Brutto has reported that he has no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 7, 2019.
- Revision received June 11, 2019.
- Accepted June 24, 2019.
- 2019 American College of Cardiology Foundation
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