Secondary Stroke Prevention Medications

Antiplatelet Therapy

The American Heart Association recommends aspirin 81-325 mg daily for secondary stroke prevention in patients with non-cardioembolic stroke 1, 2
The American College of Cardiology recommends clopidogrel 75 mg daily as an alternative option with similar efficacy to aspirin for secondary stroke prevention in patients with non-cardioembolic stroke 1, 2
The American Stroke Association recommends aspirin 25 mg plus extended-release dipyridamole 200 mg twice daily as another recommended combination for secondary stroke prevention in patients with non-cardioembolic stroke 1, 2
Dual antiplatelet therapy (aspirin plus clopidogrel) is not recommended beyond 21-30 days after the initial event, as it increases bleeding risk without additional benefit, according to the American Heart Association 1, 3

The American College of Cardiology recommends atorvastatin 80 mg daily for patients with ischemic stroke or TIA, particularly those with intracranial atherosclerotic stenosis 2, 4
The American Heart Association recommends a target LDL-cholesterol level of <1.8 mmol/L (70 mg/dL) for patients with atherosclerotic disease 4
Ezetimibe can be added to reach LDL goals in patients with atherosclerotic disease of extracranial or intracranial arteries, according to the American College of Cardiology 4

The American Heart Association recommends a target systolic blood pressure of <140 mmHg for patients with moderate to high-grade intracranial atherosclerotic stenosis 1, 2
The specific antihypertensive agent class should be selected based on individual comorbidities, though the blood pressure target itself is the priority, according to the American College of Cardiology 1

The American Heart Association recommends antiplatelet therapy rather than oral anticoagulants for patients with embolic stroke of undetermined source (ESUS) 1, 2
The American College of Cardiology recommends either antiplatelet therapy or oral anticoagulants for at least 3 months for patients with extracranial artery dissection 1, 5
The American Stroke Association recommends warfarin targeting INR 2.5-3.5 plus aspirin 75-100 mg daily for mechanical mitral valves with prior stroke 4

The American College of Cardiology recommends determining stroke mechanism to guide medication selection, with cardioembolic (atrial fibrillation) indicating oral anticoagulation (DOAC preferred) 4
The American Heart Association recommends selecting antiplatelet regimen (for non-cardioembolic) based on individual patient characteristics, with options including aspirin 81-325 mg daily, clopidogrel 75 mg daily, or aspirin/dipyridamole combination 1, 2
The American College of Cardiology recommends adding statin therapy, with atorvastatin 80 mg daily for all patients with ischemic stroke 2, 4
The American Heart Association recommends optimizing blood pressure, with a target systolic BP <140 mmHg with appropriate antihypertensive agents 1, 2