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J Am Coll Cardiol. 2019 Aug 13;74(6):786-803. doi: 10.1016/j.jacc.2019.06.039.

Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease: JACC Scientific Expert Panel.

Author information

1
Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida. Electronic address: vjdelbrutto@gmail.com.
2
Department of Neurology, University of Maryland, Baltimore, Maryland.
3
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
4
Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida.
5
Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida. Electronic address: rsacco@med.miami.edu.

Abstract

Stroke survivors carry a high risk of recurrence. Antithrombotic medications are paramount for secondary prevention and thus crucial to reduce the overall stroke burden. Appropriate antithrombotic agent selection should be based on the best understanding of the physiopathological mechanism that led to the initial ischemic injury. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis and endothelial injury, whereas anticoagulant agents are favored for cardiogenic embolism and highly thrombophilic conditions. Large randomized controlled trials have provided new data to support recommendations for the evidence-based use of antiplatelet agents and anticoagulant agents after stroke. In this review, the authors cover recent trials that have altered clinical practice, cite systematic reviews and meta-analyses, review evidence-based recommendations based on older landmark trials, and indicate where there are still evidence-gaps and new trials being conducted.

KEYWORDS:

anticoagulants; antiplatelets; antithrombotics; ischemic stroke; secondary prevention

PMID:
31395130
DOI:
10.1016/j.jacc.2019.06.039

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