Dual versus mono antiplatelet therapy for acute non- cardio embolic ischemic stroke or transient ischemic attack- Christessa Emille Que Albay - Cardinal Santos Medical Center

New evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention has been realized in the recent years. An updated meta-analysis was done to determine the effect of the various dual antiplatelets (including ticagrelor and cilostazol) vs aspirin alone on recurrence rate of ischemic stroke, cardiovascular morbidity and mortality, and its safety profile as reported through major bleeding.

Introduction:

Ischemic stroke is a far the most common type of stroke accounting for an approximately 80–90% of all strokes. According to World Health Organization (WHO) the cerebrovascular accidents or stroke are the second leading cause of mortality and the third leading cause of morbidity. It is a condition in which a region of the brain is deprived of blood flow which results to hypoxia of brain cells leads to the cell death and thereby resulting to the focal neurologic deficits depending on the area of damage. Transient ischemic attack on the other hand presents a similarly with an ischemic strokes but do not leave the evidence of damaged tissue. Transient impairment of blood flow occurs which reverses spontaneously without intervention.

Stroke is the only leading cause of long disability. In addition to the initial damage progression of focal deficits result to unfavorable outcomes. In past decades the intensive therapeutic and interventional strategies have been investigated to reduce the disability and recurrence of the stroke. According to Aoki, et al. the intravenous thrombolysis, endovascular therapy and aspirin have played key roles in reducing the stroke recurrence. Lifted from several prospective randomized controlled trials such as the ‘chance’ and point trials. The addition of clopidogrel to aspirin significantly decreased the neurologic deterioration in patients with acute non cardioembolic ischemic strokes. Other dual anti-platelet therapies have also been showed the positive impact. The management of ischemic strokes which have given rise to the several systematic reviews and also meta-analysis of these drugs. However, the subsequent pilot studies with a small population size involving antiplatelet drugs such as ticagrelor and cilostazol. When combined with aspirin did not confirm whether the clinical outcomes of patients with acute stroke would improve.

Author(s): Christessa Emille Que Albay

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