antiplatelet drugs for secondary prevention of stroke

Last edited 04/2018

Patients with stroke or TIA should receive two weeks of aspirin followed by definitive anti-platelet treatment (1):

• clopidogrel is recommended as an option to prevent occlusive vascular events:
  • for people who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease or
  • for people who have had a myocardial infarction only if aspirin is contraindicated or not tolerated
    
    
• modified-release dipyridamole in combination with aspirin is recommended as an option to prevent occlusive vascular events:
  • for people who have had a transient ischaemic attack or
  • for people who have had an ischaemic stroke only if clopidogrel is contraindicated or not tolerated
    
    
• modified-release dipyridamole alone is recommended as an option to prevent occlusive vascular events:
  • for people who have had an ischaemic stroke only if aspirin and clopidogrel are contraindicated or not tolerated or
  • for people who have had a transient ischaemic attack only if aspirin is contraindicated or not tolerated

People currently receiving clopidogrel or modified-release dipyridamole either with or without aspirin outside the criteria detailed above should have the option to continue treatment until they and their clinicians consider it appropriate to stop

Reference:

• (1) NICE (December 2010) - Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular events