Abstract
Antiplatelets are among the most commonly used drugs to reduce the risk of cardiovascular events in patients with transient Ischemic Attack and cerebral infarction. In the primary prevention stage its use is limited, and this will depend on the cardiovascular risk measured by scales such as the Framingam risk scale. In secondary prevention they have already demonstrated their usefulness as monotherapy (aspirin or clopidogrel) or dual therapy especially in the acute stage of minor cerebral infarction (aspirin / clopidogrel for 21 days). Other lines of research include the combined use of aspirin with direct anticoagulants or triple therapies. In this review article we show the published evidence on the benefit of antiplatelets in the prevention of cerebral infarction.
References
Smith P, Arnesen H, Holme I. The effect on mortality and reinfarction after myocardial infarction. N Engl J Med 1990;323-147-152
doi:10.1056/NEJM199007193230302
Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas J-L, Goto S, Liau C-S, Richard AJ, Röther J, Wilson PWF, REACH Registry Investigaros. Internacional prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006;295:180-189. doi:10.1001/jama.295.2.180
Antithrombotic Trialist´s (ATT) Collaboration, Biagent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-1860. doi:10.1016/S0140-6736(09)60503-1
Caldeira D, Alves M, David C, Costa J, Ferreira JJ, Pinto FJ. Aspirin in the primary prevention of cardiovascular disease on diabetic patients: Systematic review and meta-analysis. Prim Care Diab (2019), https://doi.org/10.1016/j.pcd.2019.11.004
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Moñuz D, Smith Jr SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 AAC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Curculation 2019;140:e563-e595. doi:10.1161/CIR.0000000000000677
Algra A, van Gijn J. Aspirin at any dose above 30 mg offers only modest protection after cerebral ischaemia. J Neurol Neurosurg Psychiatry 1996;60:197-199. doi:10.1136/jnnp.60.2.197
Antithrombotic Trialists’ Collaboration (2002) Collaborative Meta-Analysis of Randomized Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. BMJ 2002;324:71-86. doi:10.1136/bmj.324.7329.71
Antithrombotic Trialists' (ATT) Collaboration; Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney C, Meade T, Patrono C, Roncaglioni MC, Zanchetti A. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-1860. doi:10.1016/S0140-6736(09)60503-1
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329-1339. doi:10.1016/s0140-6736(96)09457-3
Diener H-Ch, Brass LM, Kaste M. 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;364:331-337. doi: 10.1016/S0140-6736(04)16721-4
Diener H-Ch, Brass LM, Kaste M. 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;364:331-337. doi: 10.1016/S0140-6736(04)16721-4
Bhatt DL, Fox KAA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston C, Mak K-H, Mas J-L, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ, for the CHARISMA Investigators. Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. N Eng J Med 2006;354:1706-1717. doi:10.1056/NEJMoa060989
Sacco RL, Diener H-C, Yusuf S, Cotton D, Ounpuu S, Lawton WA, Palesch Y, Martin RH, Albers GW, Bath P, Bornstein N, Chan BPL, Chen S-T, Cunha L, Dahlöf B, De Keyser J, Donnan JA, Estol C, Gorelick P, Gu V, Hermansson K, Hilbrich L, Kaste M, Lu M, Machnig T, Pais P, Roberts R, Skvortsova R, Teal P, Toni D, Vandermaelen C, Voigt T, Weber M, Yoon BW, PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008;359:1238-1251. doi:10.1056/NEJMoa0805002
SPS3 Investigators; Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CH, Pearce LA. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J med 2012;367:817-825. doi:10.1056/NEJMoa1204133
Chen Z, Sandercock P, Pan HC, Counsell C, Collins R, Liu LS, Xie X, Warlow C, Peto R. Indications for early aspirin use in acute ischemic stroke : A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke 2000;31:1240-12249. doi:10.1161/01.str.31.6.1240
Wang Y, Wang Y, Zhao C, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC, CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11-19. doi:10.1056/NEJMoa1215340
Johnston SC, Easton JD, Farrant M, Barsan W, et al., for the Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018;379:215-225. doi:10.1056/NEJMoa1800410
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, et. al, for the COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med 2017;377:1319-1330. doi:0.1056/NEJMoa1709118
Toyoda K, Uchiyama S, Yamaguchi T, Easton JD, Kimura K, Hoshino H, Sakai N, Okada Y, Tanaka K, Origasa H, Naritomi H, Houkin K, Yamaguchi K, Isobe M, Minematsu K, on behalf of the CSPS.com Trial Investigators. Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial. Lancet Neurol 2019;18:539-548. dio:10.1016/S1474-4422(19)30148-6
Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Evans SR, Held P, Jonasson J, Minematsu K, Molina CA, Wang Y, Wong KSL, for the SOCRATES Steering Committee and Investigators. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. N Engl K Med 2016;375:35-43. doi:10.1056/NEJMoa1603060
Johnston SC, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, Knutsson M, Ladenvall P, Molina CA, Wang Y, THALES Investigators. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N ENgl J Med 2020;383:207-217. doi:10.1056/NEJMoa1916870
Bath PM, Woodhouse LJ, Appleton JP,Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Flaherty K, Havard D, Heptinstall S, James M, Krishnan K, Markus HS, Montgomery AA, Pocock SJ, Randall M, Ranta A, Robinson TG, Scutt P, Venables GS, Sprigg N, for the TARDIS Investigators. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet 2018;391:850-859. doi:10.1016/S0140-6736(17)32849-0
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker C, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL, on behalf of the American Heart Association Stroke Council. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019;50:e344-e418. doi:10.1161/STR.0000000000000211
Greving JP, Diener HC, Reitsma JB, Bath PM, Csiba L, Hacke W, Kappelle LP, Koudstaal PJ, Leys D, Mas JL, Sacco RL, Algra A, for the Cerebrovascular Antiplatelet Trialists’ Collaborative Group. Stroke 2019;50:1812-1818. doi:10.1161/STROKEAHA.118.024497
Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S, Kreuzer J, Cronin L, Cotton D, Grauer C, Brueckmann M, Chernyatina M, for the RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med 2019;380:1906-1917. doi:10.1056/NEJMoa1813959
Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, Swaminathan B, Lavados P, Wang Y, Wang Y, Davalos A, Shamalov N, Mikulik N, Cunha L, Lindgren A, Arauz A, Lang W, Czlonkowska A, Eckstein J, Gagliardi RJ, Amarenco P, Ameriso SF, Tatlisumak T, Veltkamp R, Hankey GJ, Toni D, Bereczki D, Uchiyama S, Ntaios G, Yoon BW, Brouns R, Endres M, Muir KW, Bornstein N, Ozturk S, O’Donnell MJ, De Vries Basson MM, Pare G, Pater C, Kirsch B, Sheridan P, Peters G, Weitz JI, Peacock WF, Shoamanesh A, Benavente OR, Joyner C, Themeles E, Connolly SJ, for the NAVIGATE ESUS Investigators. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med 2018;378:2191-2201. doi:10.1056/NEJMoa1802686
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2021 Revista de Medicina Clínica