Antiplatelet Therapy in Cerebral Small Vessel Disease

Purpose of Review We critically evaluate the evidence for the use of antiplatelet therapy for stroke prevention following lacunar stroke and in patients with hemorrhage-prone cerebral small vessel disease. Recent Findings Pooled lacunar stroke subgroup analyses of all relevant randomized controlled...

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Bibliographic Details
Published in:Current neurology and neuroscience reports 2019-09, Vol.19 (9), p.61-8, Article 61
Main Authors: Bouasquevisque, Danielle de sa, Benavente, Oscar R., Shoamanesh, Ashkan
Format: Article
Language:English
Subjects:
Aspirin - administration & dosage
Cerebral Hemorrhage - physiopathology
Cerebral Hemorrhage - prevention & control
Cerebral Small Vessel Diseases - drug therapy
Cerebral Small Vessel Diseases - physiopathology
Clinical trials
Clopidogrel - administration & dosage
Drug Therapy, Combination
Hemorrhage
Humans
Magnetic resonance imaging
Medicine
Medicine & Public Health
Neurology
Neurosciences
Phosphodiesterase
Phosphodiesterase inhibitors
Platelet Aggregation Inhibitors - administration & dosage
Platelet Aggregation Inhibitors - therapeutic use
Randomized Controlled Trials as Topic - methods
Secondary Prevention - methods
Section Editor
Stroke
Stroke (H.C. Diener
Stroke - physiopathology
Stroke - prevention & control
Topical Collection on Stroke
Vascular diseases
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Summary:Purpose of Review We critically evaluate the evidence for the use of antiplatelet therapy for stroke prevention following lacunar stroke and in patients with hemorrhage-prone cerebral small vessel disease. Recent Findings Pooled lacunar stroke subgroup analyses of all relevant randomized controlled trials to date suggest a 22% relative risk reduction in recurrent stroke by single antiplatelet therapy (RR 0.77, 95% CI 0.62–0.97) compared with placebo, no consistent suggestion of variable efficacy amongst specific antiplatelet agents, and the absence of clear benefit with dual over single antiplatelet therapy. Current data does not support withholding antiplatelet therapy where otherwise indicated in patients with cerebral microbleeds on MRI or those who have suffered intracerebral hemorrhage. Summary Antiplatelet monotherapy appears to provide persistent secondary stroke prevention in patients with lacunar stroke. Whether phosphodiesterase inhibitors, particularly cilostazol, provide additional advantage in patients with cerebral small vessel disease is worthy of further investigation.
ISSN:1528-4042
1534-6293
DOI:10.1007/s11910-019-0979-y