Antiplatelets in acute management and prevention of transient ischemic attack and stroke

Abstract

Introduction: Antiplatelet drugs (AD) reversibly or irreversibly inhibit activation and platelet aggregation and hence inhibit genesis of thrombus. Methods: In this article, we review the administration of AD in acute stroke management as well as in the primary and secondary prevention of stroke and transient ischemic attack (TIA). Conclusions: For primary stroke prevention of the first ever stroke, aspirin is advised only when a 10-year vascular risk is more than 10%, patient has a likely survival of >10 years and has a low risk for hemorrhage. For patients with acute ischemic stroke (AIS) or TIA administration of aspirin is strongly recommended within 24–48 h of symptom onset. For patients managed with IV thrombolysis, aspirin administration should be deferred for 24 h. For patients with recent minor non cardioembolic AIS and a National Institutes of Health Stroke Scale (NIHSS) score ≤3 or patients with a high-risk TIA with ABCD2 score ≥4, dual Antiplatelet therapy with aspirin and clopidogrel should be started within 12–24 h of stroke or TIA onset and definitely within a week of onset and then should be continued for a period of 21–90 days, followed by switching to a single antiplatelet therapy. The US Food and Drug Administration has given approval for Ticagrelor usage to prevent the risk of for stroke recurrence in patients with AIS with a NIHSS score of ≤5 or high-risk TIA where ticagrelor – Aspirin combination maybe prescribed for 30 days. For patients who are carriers of CYP2C19 a 90-day ticagrelor – Aspirin offers better stroke prevention. ADs in dual combination for short term and single agent in the long term remain the dominant therapy for prevention of non-cardioembolic ischemic stroke.