Pharmacological Secondary Prevention of Ischemic Stroke

Han-Jin Cho; Tae-Ho Kang

doi:10.12786/bn.2014.7.2.76

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Cho and Kang: Pharmacological Secondary Prevention of Ischemic Stroke

Review

Brain & Neurorehabilitation 2014; 7(2): 76-85.

Published online: 29 September 2014

DOI: https://doi.org/10.12786/bn.2014.7.2.76

Pharmacological Secondary Prevention of Ischemic Stroke

Han-Jin Cho, M.D., Tae-Ho Kang, M.D.

Department of Neurology, Pusan National University School of Medicine, Korea.

Correspondence to: Han-Jin Cho, Department of Neurology, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: 051-240-7317, Fax: 051-245-2783, chohj75@gmail.com

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.

Keywords: antiplatelet agent, anticoagulant, secondary prevention, ischemic stroke

Figures and Tables

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.

Table 1

Current Recommendations for Antithrombotic Therapy in Patients with Ischemic Stroke from Korean Clinical Practice Guidelines for Stroke

TIA: transient ischemic attack, AF: atrial fibrillation, INR: international normalized ratio.

Table 2

Prevention of Ischemic Stroke in Patients with Atrial Fibrillation

INR: international normalized ratio, CHADS₂: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke.

Notes

This work was supported by a clinical research grant from Pusan National University Hospital in 2014.

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