Portal de Periódicos da CAPES

Drugs in secondary stroke prevention

2021; NPS MedicineWise; Volume: 44; Issue: 3 Linguagem: Inglês

10.18773/austprescr.2021.018

1839-3942

Chris Tremonti, Mark J. Thieben,

Lipoproteins and Cardiovascular Health

After an ischaemic stroke or transient ischaemic attack, patients have a high risk of having another stroke.Secondary stroke prevention includes antiplatelet therapy, statins and antihypertensives.Aspirin, clopidogrel, or a combination of aspirin with dipyridamole are first-line options for secondary stroke prevention in the absence of atrial fibrillation.Dual antiplatelet therapy has a benefit in the first three weeks after stroke, but patients should change to a single antiplatelet drug after this time.Anticoagulants are indicated if the patient has atrial fibrillation.Avoid combinations of anticoagulants and antiplatelet drugs.Patients should be started on statins after an ischaemic stroke.High doses are recommended even if cholesterol concentrations are normal.Antihypertensive drugs are recommended for all patients with systolic blood pressures greater than 140/90 mmHg.ACE inhibitors, calcium channel blockers and diuretics are first-line options. P2Y 12 inhibitorsClopidogrel, a P2Y 12 inhibitor, has efficacy for secondary stroke prevention at doses of 75 mg. 10A 2019 meta-analysis found a benefit for clopidogrel over aspirin and aspirin/dipyridamole for reducing major bleeding and intracranial haemorrhage.