What is the best drug treatment for preventing a stroke?

This study investigated what antiplatelet drugs are most effective and safe for preventing stroke in patients with cardiovascular disease or who have a history of stroke. 

A stroke is a disturbance of blood flow to a part of the brain. Most strokes are caused by a blood clot in an artery that blocks blood flow to the brain. This is known as an ischemic stroke.

Cardiovascular disease refers to when blood vessels become narrowed or blocked from a build up of fatty plaques. The plaques can damage the blood vessels, causing the development of blood clots. This puts individuals with cardiovascular disease at risk of having an ischemic stroke. Patients who have had a stroke also have a high risk of having a recurrent stroke.

Drugs, called antiplatelets, can stop blood clots from forming and therefore help prevent a stroke. However, blood clotting is needed to stop internal bleeding if a blood vessel were to burst or get injured. Therefore, an adverse effect of antiplatelets is a brain hemorrhage which is a burst blood vessel inside the skull.

This study investigated which antiplatelet drugs or regimens are effective (prevent stroke) and safe (low risk of brain hemorrhage) in patients who either have cardiovascular disease (primary prevention) or who have a history of stroke (secondary prevention).

The study carried out a review of past clinical trials that investigated antiplatelet drugs and regimens such as aspirin (Acuprin) alone, or as dual antiplatelet therapy with clopidogrel (Plavix), prasugrel (Effient) or ticagrelor (Brilinta). A total of 22 past studies comprising of over 173,000 patients were included in the review.  

The study found that dual antiplatelet therapy with aspirin and clopidogrel in comparison to aspirin alone reduced the risk of all types of stroke by 20% and the risk of ischemic stroke by 23% without increasing the risk of brain hemorrhage.

In patients who had a history of stroke or minor stroke, aspirin with clopidogrel also reduced the risk of stroke by 24% as compared with aspirin alone. Aspirin with prasugrel or ticagrelor when compared to aspirin with clopidogrel were not associated with a reduced risk of stroke. 

The study concluded that dual antiplatelet therapy with aspirin (e.g. 75-100mg) and clopidogrel (e.g. 75mg), compared with aspirin alone, effectively reduces the risk of stroke in patients with cardiovascular disease without increasing the risk of brain hemorrhage, and also decreases the risk of recurrent stroke.

This study was published in December 2013, and although more recent studies have been published since we feel the results are still important due to the risks surrounding stroke nad recurrent stroke. 

If you or someone you know have cardiovascular disease or have had a history or stroke or nimor stroke, talk to a doctor about the option of receiving aspirin with clopodigrel to prevent stroke.