[Thromboprophylaxis for cerebrovascular disorders: acetylsalicylic acid remains the cornerstone]

Abstract

Antithrombotic medication plays a key role in the treatmentand secondary prophylaxis of atherothrombotic conditions. Numerous studies have found that acetylsalicylic acid is effective in reducing the incidence of (recurrent) acute vascular events, such as myocardial infarction or ischaemic stroke. For coronary atherothrombosis, anticoagulation with vitamin K antagonists was shown to be slightly superior to acetylsalicylic acid in high-risk patients. Two major trials, the 'Stroke prevention in reversible ischemia trial' (SPIRIT) and the 'European/Australasian stroke prevention in reversible ischaemia trial' (ESPRIT), showed that vitamin K antagonists were more effective than placebo in the prevention of ischaemic stroke, but the favourable effect was completely offset by a higher incidence of major bleeding (including intracerebral bleeding) in patients using vitamin K antagonists. In the ESPRIT trial, the combination of acetylsalicylic acid and dipyridamole provided a modest benefit over acetylsalicylic acid alone in the prevention of (recurrent) ischaemic stroke.