When are anticoagulant and antiplatelet therapies indicated for the prevention of recurrent posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Long-term anticoagulation with warfarin is indicated in several settings—including atrial fibrillation, selected cases with significant global or regional cardiac hypokinesis (ejection fraction < 35%), patent foramen ovale with documented hypercoagulable condition, and arterial hypercoagulable state—for prevention of recurrent strokes.  Novel anticoaguants, including dabigatran, rivaroxaban and apixaban, may be used for stroke prevention in the context of non-valvular atrial fibrillation.  The risks of recurrent stroke have to be balanced with the risk of oral anticoagulation therapy. For patients in whom no cause for recurrent strokes can be found despite extensive work-up, antiplatelet therapy is generally recommended instead of anticoagulation therapy.

Antiplatelet therapies are often the mainstay of recurrent stroke prevention. In most cases, they can be instituted immediately, and evidence suggests that doing so decreases recurrent events immediately and chronically. Aspirin, 325 mg daily, has been shown to reduce the rate of acute recurrence of stroke (ie, in the first 14 days after first stroke) when administered within 48 hours of the first stroke.

Ticlopidine, clopidogrel, and aspirin plus extended-release dipyridamole (Aggrenox) also prevent recurrent stroke, although ticlopidine is rarely used due to a higher risk of side effects. These agents produce platelet inhibition by a number of different mechanisms.


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