Role of Antiplatelet Drugs in Treatment of Acute Ischemic Stroke

Authors

  • พรภัทร ธรรมสโรช ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์

Keywords:

antiplatelet, stroke

Abstract

Patients with acute ischemic stroke who have indications and no contraindication should be treated with intravenous thrombolysis and/or mechanical thrombectomy. However, majority of the patients do not receive those treatment. Aspirin is still recommended in treating patients with acute ischemic stroke within 24 hours. There was more evidence for combination of aspirin and clopidogrel in treating patients with acute ischemic stroke, which was proven for benefit over aspirin in reducing rate of recurrent stroke. Besides aspirin, combination of aspirin and clopidogrel is recommended to treat patients with acute minor stroke or TIA within 24 hours and continue for 90 days; with lower-strength of recommendation.

References

Dharmsaroja PA. Controversies of thrombolytic therapy in acute ischemic stroke. J Thai Stroke Soc 2016; 15: 75-81.

Dharmasaroja PA, Ratanakorn D, Nidhinandana S, et al. Thai guidelines of endovascular treatment in patients with acute ischemic stroke. J Thai Stroke Soc 2016; 15: S1-S29.

Patrano C, Coller B, Dalen JE, et al. Platelet-active drugs: the relationships among dose, effectiveness, and side effects. Chest 2001; 119: 39S-63S.

Dharmasaroja PA. Aspirin and clopidogrel resistance. In Dharmasaroja PA, ed. Ischemic Stroke. Bangkok, Jarunsanitwongkanpim 2012; 179-194.

Mega JL, Simon T. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. Lancet 2015; 386: 281-291.

Dharmasaroja PA. Prevention of ischemic stroke. In Dharmasaroja PA, ed. Ischemic Stroke. Bangkok, Jarunsanitwongkanpim 2012; 213-258.

Jainan W, Vilaichone RK. Effects of the CYP2C19 genetic polymorphism on gastritis, peptic ulcer disease, peptic ulcer bleeding and gastric cancer. Asian Pac J Caner Prev 2014; 15: 10957-10960.

The International Stroke Trial (IST). A randomized trial of aspirin, subcutaneous heparin, both or neither among 19435 patients with acute ischemic stroke. Lancet 1997; 349: 1561-81.

CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomized placebo-controlled trial of early aspirin use in 20000 patients with acute ischemic stroke. Lancet 1997; 349: 1641-9.

Klijn CJM, Hankey GJ. Management of acute ischemic stroke: new guidelines for the American Stroke Association and European Stroke Initiative. Lancet Neurol 2003; 2: 698-701.

Dengler R, Diener HC, Schwartz A, et al. Early treatement with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke
within 24 h of symptom onset (EARLY trial): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010; 9: 159-166.

Kennedy J, Hill MD, Ryckborst K, et al. Fast assessment to stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol 2007; 6: 961-969.

Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369: 11-19.

Johnston SC, Amarenco P, Albers GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med 2016; 375: 35-43.

https://clinicaltrials.gov/ct2/show/NCT 00991029 เข้าถึง website เมื่อ 30 มีนาคม 2559

Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals
from the American Heart Association/American Stroke Association. Stroke 2013; 44: 870-947.

Kernan WN, Ovbiagele B, Black HR, et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare
professionals from the American Heart Association/ American Stroke Association. Stroke 2014; 45: 2160-236.

Downloads

Published

2019-02-13

How to Cite

1.
ธรรมสโรช พ. Role of Antiplatelet Drugs in Treatment of Acute Ischemic Stroke. J Thai Stroke Soc [Internet]. 2019 Feb. 13 [cited 2024 May 2];17(1):32-40. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172064

Issue

Section

Original article