By Matthew E. Fink, MD

Louis and Gertrude Feil Professor in Clinical Neurology and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a consultant for Procter & Gamble and Pfizer.

SOURCE: Kim JT, Park MS, Choi KH, et al. Different antiplatelet strategies in patients with new ischemic stroke while taking aspirin. Stroke 2016;47:128-134.

Patients presenting with acute ischemic stroke often take aspirin on a regular basis for prevention of cardiovascular disease. The optimal antiplatelet therapy for secondary prevention has been uncertain in this setting.

The authors of this study analyzed 1,172 patients in a prospective, multicenter stroke registry database from 14 hospitals in South Korea, selecting patients with acute non-cardioembolic stroke, who were taking aspirin for prevention of cardiovascular disease at the time of onset of stroke.

These patients were then divided into three groups, 1) maintaining aspirin monotherapy (MA group = 212), 2) switching aspirin to another antiplatelet agent (SA group = 246), and 3) adding another antiplatelet agent to aspirin (AA group = 714). Researchers followed the patients for one year, using a primary endpoint of a composite of all stroke, myocardial infarction, and vascular death. The results were analyzed in a Cox proportional hazards regression analysis. After one year of follow-up, compared to the aspirin-only group, there was a reduction in the composite vascular event rate compared to the SA group (hazard ratio [HR], 0.50; P = 0.03) and in the AA group (HR, 0.40; P < 0.001).

This study strongly suggests that compared with maintaining patients on aspirin alone, switching to a different antiplatelet agent, or adding a second antiplatelet agent to aspirin, may be better in preventing subsequent vascular events in patients who experienced a new ischemic stroke while taking aspirin.