Ischemic stroke: Update on prevention part 2, the role of statins and antiplatelet agents

Statins reduce stroke risk in patients with coronary artery disease (CAD); a recent study demonstrated that statins are also effective in patients with previous stroke or transient ischemic attack who do not have CAD. In patients with peripheral artery disease, antiplatelet therapy with clopidogrel is more effective than aspirin therapy. However, in other patient populations, the choice of an antiplatelet agent can be based on cost and side-effect profiles. Combination therapy with dopidogrel and aspirin is recommended only for patients who have a cardiac indication for such therapy and for those in whom a stent has recently been placed. If, despite risk factor modification and antiplatelet therapy, a patient has recurrent stroke, it is important to reevaluate for both common and less common stroke mechanisms and to modify preventive strategies accordingly.