How are antiplatelet agents used after stroke?
Patients who do not meet criteria for anticoagulation should receive antiplatelet therapy: aspirin, clopidogrel, or extended-release dipyridamole plus aspirin.
All are similarly efficacious, decreasing stroke risk 14% to 18%.
Ensuring adherence is probably more important than the agent used, so choice should be guided by comorbidities, tolerability, and cost. Clopidogrel may be preferred for patients with peripheral vascular disease, chronic nonsteroidal antiinflammatory drug use, or drug-eluting stents.
Aspirin is a good choice when not contraindicated, particularly for patients on proton pump inhibitors or when the cost of alternatives would hinder compliance.
Antiplatelet therapy should be initiated immediately in patients who are not tPA candidates and do not have any hemorrhagic component.
Wait 24 hours after tPA to start antiplatelet medications.
