Purpose of Review

Antiplatelet therapy remains the standard of care in secondary stroke prevention for non-cardioembolic ischemic stroke and transient ischemic attack. We aim to examine the use of antiplatelet agents in secondary prevention through highlighting relevant clinical trials and meta-analyses as well as providing commentary regarding our practice.

Recent Findings

In the POINT and CHANCE trials, dual antiplatelet therapy reduced recurrent stroke compared to aspirin monotherapy. Sub-analyses of these trials suggest that genetic polymorphisms could play a role in diminishing the effectiveness of clopidogrel. Similarly, THALES demonstrated better outcomes with ticagrelor-aspirin combination therapy over aspirin monotherapy.

Summary

Combination antiplatelet therapy with aspirin and the P2Y12 inhibitors, clopidogrel and ticagrelor, reduced stroke recurrence in those presenting with mild ischemic stroke or high risk TIA. Genetic polymorphisms may play a role in determining the appropriate regimen. Questions remain regarding the optimal duration of combination antiplatelet therapy for various stroke etiologies.

中文翻译：

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缺血性卒中二级预防中抗血小板治疗的临床进展

审查目的

抗血小板治疗仍然是非心源性栓塞性缺血性卒中和短暂性脑缺血发作二级卒中预防的护理标准。我们的目标是通过突出相关的临床试验和荟萃分析以及对我们的实践提供评论来检查抗血小板药物在二级预防中的使用。

最近的发现

在 POINT 和 CHANCE 试验中，与阿司匹林单药治疗相比，双重抗血小板治疗减少了复发性卒中。这些试验的子分析表明，遗传多态性可能在降低氯吡格雷的有效性方面发挥作用。同样，泰雷兹显示替格瑞洛-阿司匹林联合治疗优于阿司匹林单药治疗。

概括

阿司匹林和 P2Y12 抑制剂、氯吡格雷和替格瑞洛的联合抗血小板治疗减少了轻度缺血性卒中或高危 TIA 患者的卒中复发。遗传多态性可能在确定合适的治疗方案中发挥作用。对于各种卒中病因，联合抗血小板治疗的最佳持续时间仍然存在问题。