Abstract
The effectiveness of antiplatelet therapy has not been established in each subtype of ischemic stroke. We investigated the safety and efficacy of antiplatelet agents in the secondary prevention of lacunar and atherothrombotic stroke, and also compared vascular outcomes in treated patients in terms of pretreatment platelet aggregation test. We retrospectively compared the outcomes of 404 patients with lacunar and atherothrombotic stroke treated with or without antiplatelet agents (aspirin or ticlopidine).
In lacunar stroke, the average observation period was 39.5 months for 127 cases in the treatment group and 41.7 months for 198 cases who did not receive antiplatelet treatment (non-treatment group). There were no significant differences in baseline characteristics between the two groups. There was no significant difference in the overall cumulative event rate per 100 patient-years for recurrent ischemic stroke between the treatment group (4.3) and the non-treatment group (4.5). In the treatment group, the cumulative event rate was lower in the subgroup with accelerated platelet aggregability (1.5) compared with the subgroup with nonaccelerated platelet aggregability (6.1) with risk reduction of 75.4%, although the differences did not reach statistically significance.
In atherothrombotic stroke, the cumulative event rate per 100 patient-years for recurrent ischemic stroke was 4.3 for 31 cases with antiplatelet treatment and 7.8 for 48 cases without, with risk reduction of 44.9%.
Our results suggested that antiplatelet agents are not useful for preventing recurrent ischemic stroke in patients with lacunar stroke, but may be effective in patients with atherothrombotic stroke and some patients with lacunar stroke who have accelerated platelet aggregation.
