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Dual antiplatelet treatment for minor acute ischemic stroke and high-risk transient ischemic attack: have we reached the limit of antithrombotic management?

  • Georgios Tsivgoulis
    Correspondence
    Corresponding aurthor. “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece, Iras 39, Gerakas Attikis, Athens, Greece 15344
    Affiliations
    Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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  • Aristeidis H. Katsanos
    Affiliations
    Department of Neurology, McMaster University/ Population Health Research Institute, Hamilton, Canada
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Published:April 18, 2022DOI:https://doi.org/10.1016/j.ejim.2022.04.014
      In this issue of the European Journal of Internal Medicine Pomero et al. present their systematic review and meta-analysis evaluating the early use of clopidogrel and ticagrelor in addition to aspirin for the treatment of patients presenting with an acute non-cardioembolic minor acute ischemic stroke or transient ischemic attack (TIA) [
      • Pomero F
      • Galli E
      • Bellesini M
      • Maroni L
      • Squizzato A
      P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis.
      ].
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      References

        • Pomero F
        • Galli E
        • Bellesini M
        • Maroni L
        • Squizzato A
        P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis.
        Eur J Intern Med. 2022; 100: 49-58https://doi.org/10.1016/j.ejim.2022.03.017
        • Kennedy J
        • Hill MD
        • Ryckborst KJ
        • Eliasziw M
        • Demchuk AM
        • Buchan AM
        Fast assessment of 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
        • Easton JD
        • Farrant M
        • et al.
        Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.
        N Engl J Med. 2018; 379: 215-225
        • Johnston SC
        • Amarenco P
        • Denison H
        • et al.
        Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.
        N Engl J Med. 2020; 383: 207-217
        • Easton JD
        • Johnston SC
        Time to Retire the Concept of Transient Ischemic Attack.
        JAMA. 2022; 327: 813-814
        • Kargiotis O
        • Tsivgoulis G
        The 2020 breakthroughs in early secondary prevention: dual antiplatelet therapy versus single antiplatelet therapy.
        Curr Opin Neurol. 2021; 34: 45-54
        • Amarenco P
        • Lavallée PC
        • Monteiro Tavares L
        • et al.
        Five-year risk of stroke after TIA or minor ischemic stroke.
        N Engl J Med. 2018; 378: 2182-2190
        • Toyoda K
        • Uchiyama S
        • Yamaguchi T
        • et al.
        Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial.
        Lancet Neurol. 2019; 18: 539-548
        • Hankey GJ
        CSPS.com Trial of Adding Cilostazol to Antiplatelet Therapy to Reduce Recurrent Stroke.
        Stroke. 2020; 51: 696-698
        • Fiolaki A
        • Katsanos AH
        • Kyritsis AP
        • et al.
        High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke: A systematic review and meta-analysis.
        J Neurol Sci. 2017; 376: 112-116
        • Wang Y
        • Meng X
        • Wang A
        • et al.
        Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA.
        N Engl J Med. 2021; 385: 2520-2530
        • Eikelboom JW
        • Connolly SJ
        • Bosch J
        • et al.
        Rivaroxaban with or without aspirin in stable cardiovascular disease.
        N Engl J Med. 2017; 2017: 1319-1330
        • Sharma M
        • Hart RG
        • Connolly SJ
        • et al.
        Stroke outcomes in the COMPASS Trial.
        Circulation. 2019; 139: 1134-1145
        • Chong M
        • Sjaarda J
        • Pigeyre M
        • et al.
        Novel drug targets for ischemic stroke identified through mendelian randomization analysis of the blood proteome.
        Circulation. 2019; 140: 819-830
        • Katsanos AH
        • Hart RG
        New Horizons in Pharmacologic Therapy for Secondary Stroke Prevention.
        JAMA Neurol. 2020; 77: 1308-1317

      Linked Article

      • P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis
        European Journal of Internal MedicineVol. 100
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          Stroke is a leading cause of mortality and disability worldwide [1] and approximately 20 to 25% of ischemic stroke are anticipated by transient ischemic symptoms [2]. The risk of ischemic stroke ranges from 3 to 15% in the 90 days after a transient ischemic attack (TIA) or a minor ischemic stroke [3,4]. Aspirin is known to reduce the risk of recurrent stroke by approximately 20% [5,6] and it is currently considered the antithrombotic drug of choice in non-cardioembolic stroke patients [7]. Indeed, in patients with non-cardioembolic ischemic stroke, aspirin is the most effective treatment to reduce the risk of stroke recurrence during the first 3 months, and it is the only antiplatelet drug that has shown to reduce the risk of recurrent disabling ischemic stroke [8].
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