Antiplatelet therapy for stroke prevention

Antiplatelet therapy plays a major role in the secondary prevention of ischaemic stroke. The antiplatelet agents that are most used in the clinic include aspirin, dipyridamole and clopidogrel. These agents inhibit platelet activation through different mechanisms of action. Aspirin is the first-line drug in the secondary prevention of stroke; a combination of aspirin with dipyridamole produces a synergistic antithrombotic effect. Clopidogrel is slightly more effective than aspirin at reducing the risk of ischaemic events. Trials comparing the combination of aspirin and clopidogrel versus aspirin are underway. Intravenous antiplatelet therapy with glycoprotein IIb/IIIa receptor inhibitors for acute stroke and as an adjunct to carotid artery stenting appears promising. However, oral GPIIb/IIIa receptor inhibitors appear hazardous.