Precision antiplatelet therapy for the prevention of ischaemic stroke.
2021
Stroke happens to people of all ages and has become the leading cause of disability in the world.1 It is also the leading cause of death in China and fifth-leading cause of death in the USA.2 3 Prevention of stroke is the best treatment. The use of antiplatelet therapy is one of the main prevention strategies. Aspirin is the only antiplatelet drug indicated for primary or secondary stroke prevention. Since the invention of aspirin nearly 120 years ago, more antiplatelet agents are available. Clinicians can select one antiplatelet drug or the combination for a specific patient with a specific subtype of ischaemic stroke. This kind of precision antiplatelet therapy can maximise the benefit and lower the risk of haemorrhagic complications.
By acetylating serine 530 of cyclooxygenase-1, aspirin inhibits platelet generated thromboxane A2 and renders its antiplatelet effect. Aspirin is indicated for primary prevention of cardiovascular events in population between the age 40 and 59 with >10% risk over 10 years and low risk of gastrointestinal or intracranial haemorrhage.4
For secondary ischaemic stroke prevention, there are many choices, used either as a mono or dual therapy. The antiplatelet effect of dipyridamole is through its inhibition of phosphodiesterase activated through platelet cyclic AMP. From the European Stroke Prevention Study 2 trial, the combination of aspirin plus extended-release dipyridamole (ASA-ERDP) was 23% more effective than aspirin alone in secondary stroke prevention.5 However, the findings in the Aspirin and Extended-Release Dipyridamole vs Clopidogrel for Recurrent Stroke trial showed that ASA-ERDP and clopidogrel had similar rate of stroke recurrence …
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