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Anti-coagulants and Anti-platelets in Stroke

Click for information on the following:

All patients who have had a Stroke or TIA should be on an antiplatelet drug unless intolerant (rare) or they had a Haemorrhagic Stroke (bleeding).

Click here for Antiplatelet therapy guideline for Secondary Stroke prevention.

See diagram on the template.

Clopidogrel is drug of first choice if the patient is in sinus rhythm.

Click here for Antiplatelet therapy guideline for Secondary Stroke prevention.

Refer to guideline.

Clopidogrel can react with Proton Pump Inhibitors such as Omeprazole or Lansoprazole

Click here for further information on PPIs.


Aspirin:  dispersible 75mg daily.

Click here for Antiplatelet therapy guideline  for Secondary Stroke prevention.

Avoid increasing dose for simple analgesia.

Enteric coated aspirin formulations are expensive and no better tolerated.

Click here for further information on Aspirin formulations.


Dipyridamole: If taking dipyridamole, ensure that the ONLY reason is because of a previous thrombotic stroke.

Use in CHD may also worsen angina.

Consider Warfarin if patient has Atrial Fibrillation (AF)

WARFARIN or NOVEL ANTICOAGULANTS

These are first line therapy if patient has a history of Atrial Fibrillation.

Click here for AF guideline

Only prescribe warfarin AND aspirin on recommendation of an expert.

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