ANTIPLATELET THERAPY OF ISCHEMIC STROKE FROM THE POSITIONS OF EVIDENCE-BASED MEDICINE
DOI:
https://doi.org/10.11603/2312-0967.2018.4.9688Keywords:
ischemic stroke, antiplatelet drugs, evidence-based medicineAbstract
The aim of the work. Analysis and systematization of data from Cochrane reviews (CR), Systematic reviews (SR) as well as meta-analysis (MA) regarding antiplatelet therapy (APT) in ischemic stroke (IS) including modern data of evidence-based medicine (EBM).
Materials and Methods. Methods: information search, analysis and synthesis. We conducted an extended search of CR, SR and MA on APT in IS in DORIS and Medline (PubMed) databases. Period: July 2018. The research includes 4 CR and 14 SR and MA (full-text and abstract reviews). Systematization of data was conducted by the type of antiplatelet drugs and by the type of treatment (mono or dual APT, etc).
Results and Discussion. We analyzed and systematized data on the effectiveness and safety of use of acetylsalicylic acid (ASA), dipyridamole, ticlopidine, clopidogrel, glycoprotein IIb/IIIa receptor blockers (eptifibatide, abciximab, tirofiban, etc.), cilostazol, ticagrelor, triflusal in acute phase of IS and its secondary prevention. The drug of choice for both acute phase and secondary prevention of IS remains ASA. For patients with contraindications to ASA prescription alternative antiplatelet drugs (for instance, clopidogrel) can be utilized. Effectiveness and safety of some glycoprotein IIb/IIIa receptor blockers (tirofiban and eptifibatide) has proved to be not sufficiently reliable and the use of others (abciximab, etc.) for acute IS is potentially harmful and should be avoided. Issue of effectiveness and safety of these medications for IS treatment should be researched in any further trials. Short-term dual APT (ASA+ clopidogrel) is useful for early prevention in patients with minor stroke.
Conclusions. Based on the results of the extended search of publications regarding APT in IS on various databases in July 2018, it was established that the issue of effectiveness and safety of treatment with variety of antiplatelet drugs and their combinations remains an important research direction in stroke studies.
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