Secondary prevention of stroke: recommendation

•         ASA Vs placebo:  reduces relative stroke risk by 13-17%

•         Plavix Vs ASA: is more effective than ASA by 7.3-8.7%

•         ASA+Dipyridamole Vs ASA: more effective than ASA by 20-23%

•         ASA+Dipyridamole Vs Plavix: similar to Plavix

•         ASA+Plavix vs Plavix: No benefit, increase fatal bleeding, but reduce myocardial infarct

•         Recommendations:

1.       Plavix or ASA plus Dipyridamole: First line treatment in 2nd prevention

2. ASA is the alternative if above not available or contraindicated or patient has no insurance.

Recommendations in patient with A-Fib who has stroke:

1. 150 mg BID for pt at high risk of stroke

2. 110 mg BID for pt at high risk of bleeding or drug interaction

3. 75 mg BID for patient with renal failure (CrCl 15-30)

4. No need to switch if coumadin is using and well tolerated

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