Controversies in antiplatelet therapy in the secondary prevention of stroke

Recurrence of stroke has been estimated at 3-4% yearly after TIA or stroke. There is no clear agreement in choosing antiplatelet therapy at this time. Europeans, Americans and British guidelines have been different. Aspirin is still used in secondary prevention of ischemic stroke, because of the longest experience with the best-achieved results in different studies and low price. Other used drugs are a combination of aspirin and dipyridamole, P2Y12 receptor antagonists - clopidogrel, ticlopidine, prasugrel and ticagrelor, or inhibitor of phosphodiesterase cilostazol, which was effective with Chinese and Japanese population. The common agreement is not to use a dual antiplatelet therapy in long term, because it does not carry a higher reduction of ischemic attacks than monotherapy. The other negative effect is causing more incidents with severe hemorrhage. According to the American recommendation, the combined therapy is promising early after having TIA and light stroke when the risk of recurrence of stroke is high.