TIAs: WHAT TO DO WHEN ASPIRIN IS NOT ENOUGH

Patients who experience transient ischemic attacks (TIAs) are at high risk for stroke and need preventive therapy. Aspirin is commonly used to reduce the risk of stroke in these patients. Some patients, however, may continue to experience TIAs while on aspirin therapy. Data regarding the efficacy of other antiplatelet therapies such as dipyridamole, ticlopidine, or clopidogrel in combination with aspirin are limited.

The American Heart Association recognizes the lack of evidence in this area. It recommends therapy be individualized for each patient to receive either the combination of extended-release dipyridamole and aspirin or clopidogrel 75 mg daily for secondary prevention. Clopidogrel is recommended over ticlopidine because it has a better safety profile.

Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.