CONSENSUS STATEMENT

(1) The high incidence and serious consequences of stroke make it one of the most important challenges faced by contemporary medicine. In the UK stroke is one of the three main causes of death and a major cause of long term disability. As a result it consumes more NHS resources than any other condition.

(2) At a conference convened by the Royal College of Physicians of Edinburgh, a consensus panel considered four specific issues relating to the medical management of cerebrovascular disease in the UK. This statement is based on published research, augmented by presentations given at the meeting and expert opinion.

(3) The treatment recommendations in this consensus statement apply only to ischaemic events. Cerebral haemorrhage will need to be excluded before treatment is initiated. Whenever feasible this should be done as soon as possible with a CT scan.

What is the role of antiplatelet therapy in stroke?

(4) The beneficial role of antiplatelet agents in patients with stroke has been clearly established.

(5) Acute stroke

In acute stroke aspirin is the only proven antiplatelet agent. It should be commenced as soon as the diagnosis of cerebral infarction has been made, using a starting dose of 150–300 mg a day and continuing until decisions have been made about secondary prevention.

(6) Secondary prevention

In patients with prior ischaemic stroke or transient ischaemic attack (TIA)  treatment should be with 75–300 mg aspirin, continued long term.

(7) There is evidence that clopidogrel and the combination of aspirin and modified release dipyridamole are safe and effective alternatives to aspirin alone. There is also some evidence that they may be more effective than aspirin alone, …