Antithrombotic Therapy and the Prevention of Stroke in Older Adults
Stroke is a common neurological problem in older adults. Most patients have identifiable risk factors. Identification and treatment of such conditions can result in a significant reduction in recurrence. In addition, patients with an acute ischemic stroke require lifelong treatment with antithrombotic agents. For the vast majority of patients, acetylsalicylic acid (ASA) in a dose of 50-325mg per day is sufficient. In patients who are unable to tolerate ASA (75mg per day) clopidogrel may be an alternative. Both clopidogrel and ASA/ extended-release dipyridamole are useful alternative medications, especially in patients with recurrent symptoms. In 20% of patients the ischemic stroke may be secondary to cardioembolic causes (atrial fibrillation is the most frequent cardiac cause). In such subjects, treatment with warfarin with INRs in the range of two to three may provide better reduction in recurrence than ASA.
Key words: stroke, stroke prevention, antithrombotic agents, cardioembolic.