Antithrombotic drugs in secondary stroke prevention: still some way to go

Patients who have ischaemic stroke or a transient ischaemic attack have a high risk of recurrent ischaemic stroke. This risk is highest in the first few days after the primary ischaemic event and then slowly decreases over time. Therefore, it is important to start secondary prevention as soon as possible, ideally oriented to the pathophysiology of cerebral ischaemia in the individual patient. Early antithrombotic therapy is particularly important. Several large randomised trials have found that aspirin significantly reduces the risk of recurrent ischaemic stroke in patients without overt atrial fibrillation, with the greatest benefit in the first few weeks after transient ischaemic attack or stroke.