Antiplatelet Agents in Secondary Prevention of Stroke

Antiplatelet agents are widely used in the secondary prevention of stroke and other vascular events. The purpose of this review is to give a perspective of the factors involved in clinical practice for selecting antiplatelet drugs appropriate to the patient population.Aspirin remains the most popular drug, because it is modestly effective (approximately 25% risk reduction); however, it has undesirable side effects that are sometimes serious. The nonaspirin compounds are marginally more effective but are much more expensive and subject to commercial pressures from industry. A completely new look at these compounds is necessary, rather than spending more precious resources on "drug wars" that are expensive in time and money.A "polypill" has been previously proposed, and possibly a combination of drugs targeted at the major vascular risk factors that is given to patients within 24 hours of initial stroke symptoms and to clearly defined patient populations may prove a solution.