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 Dr. George Jacob
Heart Infocenter

Holistic-online.com

Stroke

Use of Antiplatelet Agents after Transient Ischemic Attack (TIA) and Stroke

Cerebral Ischemia First Line Therapy Second-Choice Therapy
Atherothrombotic, lacunar (small vessel disease), or Acetylsalicylic acid (ASA) 50-325 mg/day  Clopidogrel 75 mg/day

Extended-release dipyridamole ( ER-DP)  200 mg/day in combination with acetylsalicylic acid (ASA) 25 mg/twice per day

Recurrence on acetylsalicylic acid (ASA) therapy Clopidogrel 75 mg/day 

Extended-release dipyridamole ( ER-DP)  200 mg/day in combination with acetylsalicylic acid (ASA) 25 mg/twice per day

Warfarin (INR 2-3)
Cardioembolic TIA or Stroke: Defined Source
Nonvalvular atrial fibrillation Warfarin INR 2-3 (target 2.5), If warfarin contraindicated,
acetylsalicylic acid (ASA)  50-325 mg/day
Clopidogrel 75 mg/day 

Extended-release dipyridamole ( ER-DP)  200 mg/day in combination with acetylsalicylic acid (ASA) 25 mg/twice per day

Left ventricular thrombus, recent myocardial infarction (MI or heart attack) Warfarin INR 2-3 (target 2.5), 6-month therapy  If warfarin contraindicated,
acetylsalicylic acid (ASA)  50-325 mg/day
Clopidogrel 75 mg/day 

Extended-release dipyridamole ( ER-DP)  200 mg/day in combination with acetylsalicylic acid (ASA) 25 mg/twice per day

Prosthetic valvular heart disease Warfarin INR 3-4 (target 3.5), lifelong  If warfarin contraindicated,
acetylsalicylic acid (ASA)  50-325 mg/day
Clopidogrel 75 mg/day 

Extended-release dipyridamole ( ER-DP)  200 mg/day in combination with acetylsalicylic acid (ASA) 25 mg/twice per day

Cardioembolic TIA or Stroke: Possible Source 
  Antiplatelet agents  
Atherosclerotic Corotid Stenosis
> 70% Carotid endarterectomy Antiplatelet agents 
50-69% Carotid endarterectomy, Antiplatelet agents 
< 50% Antiplatelet agents  

INR = International Normalized Ratio

Source: Eugene D. Kaplan, MD, and Ralph L. Sacco, MD, MSc:, "Use of Antiplatelet Therapy for Stroke Prevention," Clinical Geriatrics, Vol. 10, Number 2, February 2002

Caution: If you suspect a stroke, seek emergency medical treatment immediately. Time is of essence.

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