Switching to or adding another antiplatelet agent when treating patients who experience ischemic stroke or a transient ischemic attack while on aspirin monotherapy is associated with decreased risk of future vascular events, especially when implemented in the first days following the event, according to research published in Stroke.

Data sourced from PubMed identified five studies in which 8,723 patients suffered ischemic stroke or a transient ischemic attack. In a meta-analysis of these data, authors Meng Lee, MD, et al., found that the addition of or a switch to another antiplatelet agent was associated with both a 32 percent reduction in the risk of major adverse cardiovascular events and a 30 percent decrease in recurrent ischemic or hemorrhagic stroke risk, when compared with the continuation of aspirin monotherapy.

Clopidogrel was used in four cohorts, while ticagrelor was used in one. Both strategies involving the addition of and switching to another antiplatelet agent showed benefit when compared with continuing aspirin monotherapy. The frequency of recurrent ischemic stroke is greatest in the first days and weeks after an index transient ischemic attack or ischemic stroke, and heightened antithrombotic treatment proved to be especially beneficial in this early period.

The study authors suggest there may be a therapeutic advantage to the implementation of another antiplatelet agent regimen among patients who have experienced ischemic stroke or attack, and are currently being treated with aspirin monotherapy. Further, randomized controlled trials of a distinct antiplatelet regimen versus aspirin monotherapy for this population seems warranted.

Keywords: Ischemic Attack, Transient, Aspirin, Ticlopidine, Stroke

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