Antiplatelet therapy in secondary stroke prevention – state of the art

Abstract Introduction Prevention of recurrent stroke using antiplatelets in patients with acute ischaemic stroke Long‐term secondary stroke prevention in non‐cardioembolic stroke The role of antiplatelets in cardioembolic stroke prevention Antiplatelets in patients with symptomatic intracranial stenosis Antiplatelets in stroke patients with patent foramen ovale Disclosures Our objective is to provide the reader with an overview as well as an update on current antiplatelet therapy for secondary stroke prevention. Relevant journals were hand‐searched by the authors to compile a broad but by far not comprehensive summary of innovative and clinically relevant studies. Aspirin, clopidogrel and the combination of dipyridamole plus aspirin are the cornerstone therapy in secondary prevention after non‐cardio‐embolic stroke or transient ischaemic attack. A head‐to‐head comparison showed no difference in the prevention of recurrent stroke between dipyridamole plus aspirin and clopidogrel. More potent antiplatelet drugs or the combination of aspirin and clopidogrel prevent more ischaemic events, but also lead to more bleeding complications. For secondary stroke prevention in patients with atrial fibrillation, oral anticoagulation is more effective than aspirin or the combination of aspirin and clopidogrel.