Long-term antiplatelet therapy in patients with high risk of stroke

Abstract

Diseases associated with atherosclerosis occupy a leading place among the causes of death in most countries of the world. Antiplatelet therapy is one of the most eff ective and promising methods of stroke prevention. Long-term use of platelet antiplatelet agents of various pharmaceutical groups in high-risk patients has become a daily clinical practice. As a result of the practical application of modern drug strategies, the life expectancy of stroke survivors is increasing. The average age of patients with cardiovascular pathology is increasing. The majority of patients receiving antiplatelet agents are over 70 years old. The number of patients continuously receiving antiplatelet agents for 10 years or more is already hundreds of thousands. In recent years, clinical guidelines have expanded the indications for the appointment of platelet antiplatelet agents of diff erent pharmaceutical groups. In neurology, clopidogrel, ticagrelor, cilostazol are allowed. However, the choice of the optimal treatment regimen in patients with cerebrovascular pathology often causes diffi culty for doctors. Standard treatment regimens for patients at high risk of stroke are based on the use of acetylsalicylic acid preparations. In some cases, patients receive a combination of antiplatelet agents: aspirin and dipyridamole. The author analyzes the results of 30 years of acetylsalicylic acid use in a patient with a high risk of thrombosis and bleeding. During this period, the patient suff ers a transient ischemic attack, ischemic stroke, hemorrhoidal bleeding and intracranial hemorrhage. The article discusses optimal solutions in choosing an antithrombotic strategy in patients with high risk of stroke on a clinical example. Based on the analysis of current clinical recommendations and scientifi c research, the article formulates the principles of long-term antiplatelet therapy for patients of older age groups with the need for long-term treatment. The main directions of diff erentiated antithrombotic therapy have been determined depending on the suspected pathogenetic subtype of ischemic stroke, the risk of bleeding, age and the expected duration of treatment.