Antithrombotics in the prevention of cerebrovascular accidents: Part I - Significance of antiplatelet treatment
Abstract
The prophylaxis of cerebrovascular accidents is based on three pillars - regimen, alteration of atherogenic risk factors and antithrombotic treatment. In patients treated within the secondary prevention of cardiovascular accidents, i.e. prophylaxis of atherothrombosis, primary haemostasis plays the dominant role and therefore, the therapy focuses on altering platelet functions.
On the contrary, in the case of atrial fibrillation or flutter, when blood stagnation with coagulation activation comes first, anticoagulants are suitable. If both the conditions coincide, both therapy modes are conveniently combined.
In the prophylaxis of vascular accidents in a patient who suffered from a cerebral accident, acetylsalicylic acid is used to alter the functions of hyperactivated thrombocytes in the first place, with clopidogrel being used as an alternative if acetylsalicylic acid cannot be administered. This alternative demonstrates a comparable effect and a comparable risk of bleeding complications.
A third option is the application of a fixed combination of a small dose of acetylsalicylic acid with dipyridamole. Such treatment equals clopidogrel in terms of efficacy and safety, while being more efficient than a subtherapeutic dose of 25 mg of acetylsalicylic acid; however, it is no more efficient than the usual ASA doses (30 to 325 mg).
Prospectively, the introduction of new drugs is presumed, in particular cilostazol, which is expected to be available in the Czech Republic in the coming years. Based on the results of on-going studies, the effect of new ADP receptor inhibitors, ticagrelor and prasugrel, is expected to be confirmed as well.