Antiplatelet and Anticoagulation Therapy

Abstract

  Oral aspirin is highly recommended for acute antithrombotic therapy and secondary prevention in ischemic stroke patients. Clopidogrel and cilostazol presented as good or better effectiveness in reducing the risk of recurrent stroke than aspirin. Dual antiplatelet agents may be used with the exception of aspirin plus dipyridamole, which is not generally recommended for secondary stroke prevention because of the associated high bleeding risk. The addition of dabigatran to warfarin therapy was approved for ischemic stroke prevention in patients with non valvular atrial fibrillation (NVAF). In addition, novel oral anticoagulants (e. g., factor Xa inhibitors : rivaroxaban, apixaban) have been tested in several ongoing large randomized trials. When administering anticoagulant agents for patients with NVAF, the estimation of the embolic and bleeding risks using CHADS₂ score, CHA₂DS₂-VASc score and HASBLED score is recommended. In the Bleeding with Antithrombotic Therapy (BAT) Study group, the characteristics of bleeding complications in Japanese antithrombotic users were reported.