Abstract
It is well established that antiplatelet therapy is effective for preventing the recurrence of noncardioembolic cerebral infarction. Although aspirin, clopiogrel, and cilostazol are widely used in Japan. The efficacies of these drugs are not sufficient. There is little evidence showing the difference in the efficacy of those drugs. It is common to choose the drug in an individual case by taking into account the characteristics of each drug, such as the side effects and the mechanism of action. Dual antiplatelet therapy (DAPT), i.e. combination of aspirin and clopidogrel, has not been recommended for the secondary prevention of ischemic stroke, because the reduction of cardiovascular events has been offset by the increase of major bleeding. However, it was shown that DAPT is effective for the patients of acute ischemic stroke in a recent study. Based on this evidence, DAPT might be both effective and safe if it was started within 24 hours from onset and lasted only for 21 days. On the other hand, novel antiplatelet drugs have been developed. New ADP receptor antagonists, which have more rapid and strong antiplatelet action with less individual differences than clopidogrel, have been approved in USA and Europe for patients with acute coronary syndrome, and phase III trials are in progress in Japan. It would be more important to select the appropriate drugs and their doses in individual patients, if the option of antiplatelet agents will increase in the future. Thus, more detailed risk assessment and information about pharmacongenomics would become required.
