Antiagregación plaquetaria en la prevención secundaria del ictus después del ESPS-2 y del CAPRIE

INTRODUCTION: Antiplatelet therapy is effective for secondary prevention of atherothrombotic stroke. Aspirin, the more frequently used antiplatelet drug, prevents 13 to 17% of ischemic events after stroke. New and more effective antiplatelet therapies are needed. DEVELOPMENT: Two large secondary stroke prevention trials have been recently published (CAPRIE and ESPS-2), including more than 25,000 patients. As well TACIP trial designed to assess the efficacy of triflusal, is close to end. The combination of ticlopidine and Aspirin has shown synergistic effect. CONCLUSIONS: Clopidogrel, like ticlopidine, increase 9% the relative risk reduction of stroke over Aspirin. Clopidogrel has a better safety profile than ticlopidine. Dipyridamole is an effective antiplatelet drug, but in combination with low doses of Aspirin is more effective. The possible efficacy of clopidogrel-Aspirin combination should be evaluated.