Antiplatelet or anticoagulant treatment if further TIA or ischaemic stroke whilst taking aspirin

There is no concensus as to the management of patients in sinus rhythm who have had a further ischaemic stroke or transient ischaemic attack (TIA) whilst on long-term antiplatelet therapy (1,2). Both clopidogrel and aspirin plus dipyridamole MR have similar rates of recurrent stroke (3).

If a person has a further ischaemic stroke or TIA whilst taking antiplatelet therapy, then they should be fully investigated for potential causes of these events. There is no agreement on the best preventive antiplatelet agent for these patients but options include:

• switching to clopidogrel
• adding clopidogrel to aspirin
• switching to warfarin

Continued efforts should be made to reduce a patients general risk factors for stroke.

Reference:

• 1. MeReC Bulletin (2003), 14 (2), 5-8.
• 2. NICE (December 2010).Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
• 3. Diener HC et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008 Oct;7(10):875-84.