New Recommendations for Stroke Prevention

For patients who have experienced a stroke or transient ischemic attack (TIA), regular use of aspirin together with extended-release dipyridamole is more effective than aspirin alone for the prevention of recurrent stroke, according to the Consensus Statement 2001, issued by the American College of Chest Physicians (ACCP).

The recommendation was based on the results of the European Stroke Prevention Study, which demonstrated that the combination of aspirin and dipyridamole (25 and 200 mg bid, respectively) was almost twice as effective as aspirin alone in reducing the risk of recurrent stroke. The combination may also be more effective than clopidogrel and has a similarly favorable profile in terms of adverse side effects. Long-term anticoagulation therapy is also recommended for the prevention of primary stroke and recurrent stroke in atrial fibrillation patients.

Tissue plasminogen activator (tPA) at a dose of 0.9 mg/kg is recommended for eligible ischemic stroke patients who can be treated within three hours of clearly defined symptom onset (grade 1a). The use of intravenous tPA for treatment of acute stroke of
> 3 but < 6 hours in duration is not recommended in unselected patients and remains investigational (grade 2b). Early aspirin therapy (160-325 mg per day) is recommended for patients with an ischemic stroke who are not receiving thrombolysis or antigcoagulation (grade 1a).

No trials have adequately evaluated full-dose anticoagulation in hyperacute (< 12 hours) stroke patients. Full-dose anticoagulation is not recommended for treatment of unselected patients with ischemic stroke (grade 2b). Acute stroke patients with restricted mobility should be treated with prophylactic low-dose subcutaneous heparin or low-molecular-weight heparin for prevention of deep venous thrombosis-pulmonary embolism (grade 1a).

"New antiplatelet agents with improved efficacy over aspirin offer tremendous opportunities for stroke prevention and the reduction of stroke-related mortality and disability,” said Dr. Gregory Albers, director of the Stanford Stroke Center (Palo Alto, CA, USA) and chairman of the ACCP expert panel on stroke and atrial fibrillation of the 6th ACCP Consensus Conference on Antithrombotic Therapy.



Related Links:
American College of Chest Physicians