Stroke Pathway - Antiplatelet Therapy
The current BOPDHB Stroke team preferred long-term anti-platelet therapy for those that do not require anticoagulation (i.e. warfarin or dabigatran) is:
- Clopidogrel 75mg od.
- Aspirin 100mg od and Dipyridamole 150mg bd as an alternative for those not able to tolerate Clopidogrel.
- Aspirin alone should only be used by those unable to tolerate Clopidogrel and Dipyridamole.
- Patients should receive long-term treatment following a transient ischaemic attack or an ischaemic stroke to reduce the risk of further cardiovascular events.
- Low dose aspirin and modified release dipyridamole or clopidogrel alone should be prescribed to all people with ischaemic stroke or TIA taking into consideration patient comorbidities. Aspirin alone can also be used, particularly in patients who do not tolerate aspirin plus dipyridamole or clopidogrel. If both aspirin and clopidogrel are contra-indicated or not tolerated, then modified-release dipyridamole alone is recommended; if both dipyridamole and clopidogrel are contraindicated or not tolerated, then aspirin alone is recommended.
- Patients with stroke associated with atrial fibrillation should be reviewed for long-term treatment with warfarin or an alternative anticoagulant (see Initial management under Ischaemic Stroke, above, and section 2.3).
- Anticoagulants are not routinely recommended in the long-term prevention of recurrent stroke, except in patients with atrial fibrillation (section 2.3).
- A statin (section 2.12) should be initiated 48 hours after ischaemic stroke or TIA symptom onset, irrespective of the patient’s serum-cholesterol concentration.
- Following the acute phase of ischaemic stroke, blood pressure should be measured and treatment initiated to achieve a target blood pressure of <130/80 mmHg (see section 2.5). Beta-blockers should not be used in the management of hypertension following a stroke, unless they are indicated for a co-existing condition.
- All patients should be advised to make lifestyle modifications that include beneficial changes to diet, exercise, weight, alcohol intake, and smoking.
Last updated : Friday, September 11, 2015
Next review date : Saturday, September 10,2016
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