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G6760 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
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Long-term antiplatelet therapy reduces the risk of serious vascular events following a stroke by about a quarter. Antiplatelet therapy, normally aspirin, should be prescribed for the secondary prevention of recurrent stroke and other vascular events in patients who have sustained an ischaemic cerebrovascular event.
Grade A recommendation SIGN 13
Further information: www.sign.ac.uk/pdf/sign13.pdf
All patients who are not anti-coagulated should be taking aspirin (50–300mg) daily, or a combination of low-dose aspirin and dipyridamole modified release (MR). Where patients are aspirin-intolerant an alternative antiplatelet agent (clopidogrel 75mg daily) should be used.
Grade A Recommendation RCP Stroke Guideline
Further information:
The National Clinical Guideline for Stroke (Royal College of Physicians of
London, 2004) now allows for the use of dipyridamole on its own: ‘all
patients with ischaemic stroke or TIA who are not on anticoagulation, should
be taking an antiplatelet agent, i.e. aspirin (50–300mg daily), clopidogrel,
or a combination of low-dose aspirin and dipyridamole modified release. Where
patients are aspirin intolerant an alternative antiplatelet agent (e.g. clopidogrel
75mg daily or dipyridamole MR 200mg twice daily) should be used.’
www.rcplondon.ac.uk/pubs/books/stroke/stroke_guidelines_2ed.pdf
Warfarin should be considered for use in patients with non-valvular atrial fibrillation.
Grade A recommendation SIGN 13
Practices should report the percentage of patients with non-haemorrhagic stroke or TIA who have a record in the last 15 months of prescribed aspirin, clopidogrel, dipyridamole MR or warfarin, or of taking OTC aspirin updated in the last 15 months.
Prepared By Jean Keenan