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  • Review Article
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Antithrombotic therapy for secondary prevention of atherothrombotic events in cerebrovascular disease

Nature Reviews Cardiology volume 13, pages 609–622 (2016)Cite this article

Subjects

Key Points

  • In noncardioembolic cerebrovascular disease (CVD), the use of antiplatelet agents rather than anticoagulants is recommended to reduce the risk of recurrent stroke and other cardiovascular events

  • Patients with prior noncardioembolic ischaemic stroke or transient ischaemic attack (TIA) can receive aspirin and clopidogrel in the setting of acute coronary syndrome (ACS) or percutaneous coronary intervention

  • New antiplatelet drugs investigated in the setting of ACS and secondary prevention should currently not be used in patients with prior ischaemic stroke or TIA

  • Duration of therapy should be individualized, considering the main determinant of risk (coronary or cerebrovascular), and the effectiveness, safety, and cost of drugs, as well as patient characteristics and preferences

  • In the setting of ischaemic stroke during antiplatelet therapy, if the patient's need for treatment offsets the risk of haemorrhagic conversion, aspirin plus clopidogrel seems to be the regimen of choice

  • If ischaemic stroke occurs during antiplatelet therapy, antiplatelet medications should not be abruptly suspended, particularly when therapy is recommended for an event such as ACS or stent implantation

Abstract

Atherothrombosis is the common underlying process for numerous progressive manifestations of cardiovascular disease, including coronary artery disease (CAD) and cerebrovascular disease (CVD). Antiplatelet therapy is the cornerstone of pharmacological management in patients with atherothrombosis. Over the past 20 years, major advances in antiplatelet pharmacotherapy have been made, particularly for the treatment of patients with CAD. The treatment of patients with concomitant CAD and CVD is complex, owing to their increased risk of both ischaemia and bleeding. When CVD arises from large artery atherosclerosis, antithrombotic therapies are essential to prevent stroke or transient ischaemic attack (TIA). However, the use of antithrombotic medications in patients with CVD can put them at high risk of intracranial haemorrhage. As such, the risk–benefit profile of various combinations of antiplatelet agents in patients with both CAD and CVD is uncertain. This Review provides a state-of-the-art account of the available evidence on antithrombotic therapies for the secondary prevention of atherothrombotic events in patients with concomitant CAD and CVD, particularly those with a history of noncardioembolic stroke or TIA.

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Figure 1: Polyvascular disease.
Figure 2: Types of stroke.
Figure 3: Rates of polyvascular disease.
Figure 4: Mechanism of action of antithrombotic agents.
Figure 5: Treatment decision algorithm for patients with a history of noncardioembolic ischaemic stroke or TIA who experience acute coronary syndrome.
Figure 6: Treatment decision algorithm for patients with a history of noncardioembolic ischaemic stroke or TIA who undergo percutaneous coronary intervention.

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References

  1. Hansson, G. K. Inflammation, atherosclerosis, and coronary artery disease. N. Engl. J. Med. 352, 1685–1695 (2005).

    Article  CAS  PubMed  Google Scholar 

  2. Yakubov, S. Polyvascular atherosclerotic disease: recognizing the risks and managing the syndrome. Curr. Med. Res. Opin. 25, 2631–2641 (2009).

    Article  CAS  PubMed  Google Scholar 

  3. Bhatt, D. L. et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 295, 180–189 (2006).

    Article  CAS  PubMed  Google Scholar 

  4. Suarez, C. et al. Influence of polyvascular disease on cardiovascular event rates. Insights From REACH Registry. Vasc. Med. 15, 259–265 (2010).

    Article  PubMed  Google Scholar 

  5. Capodanno, D., Ferreiro, J. L. & Angiolillo, D. J. Antiplatelet therapy: new pharmacological agents and changing paradigms. J. Thromb. Haemost. 11 (Suppl. 1), 316–329 (2013).

    Article  PubMed  Google Scholar 

  6. Angiolillo, D. J., Ueno, M. & Goto, S. Basic principles of platelet biology and clinical implications. Circ. J. 74, 597–607 (2010).

    Article  CAS  PubMed  Google Scholar 

  7. Franchi, F. & Angiolillo, D. J. Novel antiplatelet agents in acute coronary syndrome. Nat. Rev. Cardiol. 12, 30–47 (2015).

    Article  CAS  PubMed  Google Scholar 

  8. Baber, U. et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores From PARIS. J. Am. Coll. Cardiol. 67, 2224–2234 (2016).

    Article  PubMed  Google Scholar 

  9. Matteau, A. et al. Balancing long-term risks of ischemic and bleeding complications after percutaneous coronary intervention with drug-eluting stents. Am. J. Cardiol. 116, 686–693 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kernan, W. N. et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45, 2160–2236 (2014).

    Article  PubMed  Google Scholar 

  11. Adams, H. P. Jr et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Stroke 24, 35–41 (1993).

    Article  PubMed  Google Scholar 

  12. Centres for Disease Control and Prevention. Underlying Cause of Death 1999–2014. CDC Wonder http://wonder.cdc.gov/ucd-icd10.html (2015).

  13. Mozaffarian, D. et al. Heart disease and stroke statistics — 2015 update: a report from the American Heart Association. Circulation 131, e29–e322 (2015).

    PubMed  Google Scholar 

  14. Kleindorfer, D. et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 36, 720–723 (2005).

    Article  PubMed  Google Scholar 

  15. Johnston, S. C., Gress, D. R., Browner, W. S. & Sidney, S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 284, 2901–2906 (2000).

    Article  CAS  PubMed  Google Scholar 

  16. Amarenco, P. et al. One-year risk of stroke after transient ischemic attack or minor stroke. N. Engl. J. Med. 374, 1533–1542 (2016).

    Article  CAS  PubMed  Google Scholar 

  17. Dhamoon, M. S., Sciacca, R. R., Rundek, T., Sacco, R. L. & Elkind, M. S. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology 66, 641–646 (2006).

    Article  CAS  PubMed  Google Scholar 

  18. Lovett, J. K., Coull, A. J. & Rothwell, P. M. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology 62, 569–573 (2004).

    Article  CAS  PubMed  Google Scholar 

  19. Kolominsky-Rabas, P. L., Weber, M., Gefeller, O., Neundoerfer, B. & Heuschmann, P. U. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 32, 2735–2740 (2001).

    Article  CAS  PubMed  Google Scholar 

  20. Yusuf, S. et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N. Engl. J. Med. 345, 494–502 (2001).

    Article  CAS  PubMed  Google Scholar 

  21. Mehta, S. R. et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N. Engl. J. Med. 363, 930–942 (2010).

    Article  PubMed  Google Scholar 

  22. Chen, Z. M. et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366, 1607–1621 (2005).

    Article  CAS  PubMed  Google Scholar 

  23. Sabatine, M. S. et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N. Engl. J. Med. 352, 1179–1189 (2005).

    Article  CAS  PubMed  Google Scholar 

  24. Steinhubl, S. R. et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288, 2411–2420 (2002).

    Article  CAS  PubMed  Google Scholar 

  25. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348, 1329–1339 (1996).

  26. Bhatt, D. L. et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N. Engl. J. Med. 354, 1706–1717 (2006).

    Article  CAS  PubMed  Google Scholar 

  27. Roe, M. T. et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N. Engl. J. Med. 367, 1297–1309 (2012).

    Article  CAS  PubMed  Google Scholar 

  28. Wiviott, S. D. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 357, 2001–2015 (2007).

    Article  CAS  PubMed  Google Scholar 

  29. Montalescot, G. et al. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. N. Engl. J. Med. 369, 999–1010 (2013).

    Article  CAS  PubMed  Google Scholar 

  30. Wallentin, L. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 361, 1045–1057 (2009).

    Article  CAS  PubMed  Google Scholar 

  31. Montalescot, G. et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N. Engl. J. Med. 371, 1016–1027 (2014).

    Article  CAS  PubMed  Google Scholar 

  32. Bonaca, M. P. et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N. Engl. J. Med. 372, 1791–1800 (2015).

    Article  PubMed  Google Scholar 

  33. Bhatt, D. L. et al. Intravenous platelet blockade with cangrelor during PCI. N. Engl. J. Med. 361, 2330–2341 (2009).

    Article  CAS  PubMed  Google Scholar 

  34. Harrington, R. A. et al. Platelet inhibition with cangrelor in patients undergoing PCI. N. Engl. J. Med. 361, 2318–2329 (2009).

    Article  CAS  PubMed  Google Scholar 

  35. Bhatt, D. L. et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N. Engl. J. Med. 368, 1303–1313 (2013).

    Article  CAS  PubMed  Google Scholar 

  36. Tricoci, P. et al. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes. N. Engl. J. Med. 366, 20–33 (2012).

    Article  CAS  PubMed  Google Scholar 

  37. Morrow, D. A. et al. Vorapaxar in the secondary prevention of atherothrombotic events. N. Engl. J. Med. 366, 1404–1413 (2012).

    Article  CAS  PubMed  Google Scholar 

  38. Mega, J. L. et al. Rivaroxaban in patients with a recent acute coronary syndrome. N. Engl. J. Med. 366, 9–19 (2012).

    Article  CAS  PubMed  Google Scholar 

  39. Tsai, T. T. et al. Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J. Am. Heart Assoc. 3, e001380 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Abtahian, F. et al. Effect of prior stroke on the use of evidence-based therapies and in-hospital outcomes in patients with myocardial infarction (from the NCDR ACTION GWTG registry). Am. J. Cardiol. 107, 1441–1446 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bhatt, D. L. et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA 304, 1350–1357 (2010).

    Article  CAS  PubMed  Google Scholar 

  42. Alberts, M. J. et al. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur. Heart J. 30, 2318–2326 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ducrocq, G. et al. A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease. Circulation 127, 730–738 (2013).

    Article  PubMed  Google Scholar 

  44. Patrono, C., Garcia Rodriguez, L. A., Landolfi, R. & Baigent, C. Low-dose aspirin for the prevention of atherothrombosis. N. Engl. J. Med. 353, 2373–2383 (2005).

    Article  CAS  PubMed  Google Scholar 

  45. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324, 71–86 (2002).

  46. Antithrombotic Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy — I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 308, 81–106 (1994).

  47. The ESPS Group. The European Stroke Prevention Study (ESPS). Principal end-points. Lancet 2, 1351–1354 (1987).

  48. Sivenius, J. et al. Antiplatelet treatment does not reduce the severity of subsequent stroke. European Stroke Prevention Study 2 Working Group. Neurology 53, 825–829 (1999).

    Article  CAS  PubMed  Google Scholar 

  49. Halkes, P. H., van Gijn, J., Kappelle, L. J., Koudstaal, P. J. & Algra, A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 367, 1665–1673 (2006).

    Article  CAS  PubMed  Google Scholar 

  50. Diener, H. C. et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 7, 875–884 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Chamorro, A. TP receptor antagonism: a new concept in atherothrombosis and stroke prevention. Cerebrovasc. Dis. 27 (Suppl. 3), 20–27 (2009).

    Article  CAS  PubMed  Google Scholar 

  52. Bousser, M. G. et al. Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial. Lancet 377, 2013–2022 (2011).

    Article  CAS  PubMed  Google Scholar 

  53. Fox, K. A. & Chelliah, R. Clopidogrel: an updated and comprehensive review. Expert Opin. Drug Metab. Toxicol. 3, 621–631 (2007).

    Article  CAS  PubMed  Google Scholar 

  54. Ringleb, P. A., Bhatt, D. L., Hirsch, A. T., Topol, E. J. & Hacke, W. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke 35, 528–532 (2004).

    Article  CAS  PubMed  Google Scholar 

  55. Diener, H. C. et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364, 331–337 (2004).

    Article  CAS  PubMed  Google Scholar 

  56. Bhatt, D. L. et al. Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial. J. Am. Coll. Cardiol. 49, 1982–1988 (2007).

    Article  PubMed  Google Scholar 

  57. Hankey, G. J. et al. Effect of clopidogrel plus ASA versus ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial. Int. J. Stroke 6, 3–9 (2011).

    Article  PubMed  Google Scholar 

  58. Kennedy, J. et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 6, 961–969 (2007).

    Article  CAS  PubMed  Google Scholar 

  59. Wang, Y. et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N. Engl. J. Med. 369, 11–19 (2013).

    Article  CAS  PubMed  Google Scholar 

  60. Wang, Y. et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack (CHANCE): 1-year outcomes. Circulation 132, 40–46 (2015).

    Article  CAS  PubMed  Google Scholar 

  61. Tello-Montoliu, A., Tomasello, S. D. & Angiolillo, D. J. Prasugrel. Adv. Cardiol. 47, 39–63 (2012).

    Article  CAS  PubMed  Google Scholar 

  62. Hira, R. S. et al. Frequency and practice-level variation in inappropriate and nonrecommended prasugrel prescribing: insights from the NCDR PINNACLE registry. J. Am. Coll. Cardiol. 63, 2876–2877 (2014).

    Article  PubMed  Google Scholar 

  63. Capodanno, D., Dharmashankar, K. & Angiolillo, D. J. Mechanism of action and clinical development of ticagrelor, a novel platelet ADP P2Y12 receptor antagonist. Expert Rev. Cardiovasc. Ther. 8, 151–158 (2010).

    Article  CAS  PubMed  Google Scholar 

  64. James, S. K. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack. Circulation 125, 2914–2921 (2012).

    Article  CAS  PubMed  Google Scholar 

  65. Verheugt, F. W. Beware of novel antiplatelet therapy in acute coronary syndrome patients with previous stroke. Circulation 125, 2821–2823 (2012).

    Article  PubMed  Google Scholar 

  66. Bonaca, M. P. et al. Design and rationale for the Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial. Am. Heart J. 167, 437–444.e5 (2014).

    Article  PubMed  Google Scholar 

  67. Udell, J. A. et al. Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta-analysis of randomized trials. Eur. Heart J. 37, 390–399 (2016).

    PubMed  Google Scholar 

  68. Johnston, S. C. et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N. Engl. J. Med. http://dx.doi.org/10.1056/NEJMoa1603060 (2016).

  69. Franchi, F., Rollini, F., Muniz-Lozano, A., Cho, J. R. & Angiolillo, D. J. Cangrelor: a review on pharmacology and clinical trial development. Expert Rev. Cardiovasc. Ther. 11, 1279–1291 (2013).

    Article  CAS  PubMed  Google Scholar 

  70. Angiolillo, D. J. et al. Impact of cangrelor overdosing on bleeding complications in patients undergoing percutaneous coronary intervention: insights from the CHAMPION trials. J. Thromb. Thrombolysis 40, 317–322 (2015).

    Article  CAS  PubMed  Google Scholar 

  71. Alonso-Coello, P. et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141 (2 Suppl.), e669S–e690S (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Tendera, M. et al. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur. Heart J. 32, 2851–2906 (2011).

    Article  PubMed  Google Scholar 

  73. Gotoh, F. et al. Cilostazol stroke prevention study: a placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J. Stroke Cerebrovasc. Dis. 9, 147–157 (2000).

    Article  CAS  PubMed  Google Scholar 

  74. Shinohara, Y. et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 9, 959–968 (2010).

    Article  CAS  PubMed  Google Scholar 

  75. Bonaca, M. P. et al. New ischemic stroke and outcomes with vorapaxar versus placebo: results from the TRA 2 degrees P-TIMI 50 trial. J. Am. Coll. Cardiol. 64, 2318–2326 (2014).

    Article  CAS  PubMed  Google Scholar 

  76. Hart, R. G., Halperin, J. L. & Weitz, J. I. Vorapaxar, combination antiplatelet therapy, and stroke. J. Am. Coll. Cardiol. 64, 2327–2329 (2014).

    Article  PubMed  Google Scholar 

  77. Muniz-Lozano, A., Rollini, F., Franchi, F. & Angiolillo, D. J. Update on platelet glycoprotein IIb/IIIa inhibitors: recommendations for clinical practice. Ther. Adv. Cardiovasc. Dis. 7, 197–213 (2013).

    Article  CAS  PubMed  Google Scholar 

  78. Windecker, S. et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 35, 2541–2619 (2014).

    Article  PubMed  Google Scholar 

  79. Abciximab in Ischemic Stroke Investigators. Abciximab in acute ischemic stroke. A randomized, double-blind, placebo-controlled, dose-escalation study. Stroke 1, 601–609 (2000).

  80. Capodanno, D., Giacchi, G. & Tamburino, C. Novel drugs for oral anticoagulation pharmacotherapy. Expert Rev. Cardiovasc. Ther. 10, 473–488 (2012).

    Article  CAS  PubMed  Google Scholar 

  81. Alexander, J. H. et al. Apixaban with antiplatelet therapy after acute coronary syndrome. N. Engl. J. Med. 365, 699–708 (2011).

    Article  CAS  PubMed  Google Scholar 

  82. Hills, N. K. & Johnston, S. C. Trends in usage of alternative antiplatelet therapy after stroke and transient ischemic attack. Stroke 39, 1228–1232 (2008).

    Article  CAS  PubMed  Google Scholar 

  83. Roffi, M. et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur. Heart J. 37, 267–315 (2015).

    Article  CAS  PubMed  Google Scholar 

  84. Yeh, R. W. et al. Benefits and risks of extended duration dual antiplatelet therapy after PCI in patients with and without acute myocardial infarction. J. Am. Coll. Cardiol. 65, 2211–2221 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, Catania CT, 95124, Italy

    Davide Capodanno

  2. University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, 75390, Texas, USA

    Mark Alberts

  3. University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, 32209, Florida, USA

    Dominick J. Angiolillo

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D.C. and D.J.A. researched data for the article, discussed its content, wrote the manuscript, and reviewed and edited the article before submission. M.A. contributed to discussions of content.

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Correspondence to Dominick J. Angiolillo.

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D.C. declares receiving consultant and/or speaker honoraria from Abbott Vascular, Aspen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Sanofi-Aventis, and Stentys. M.A. declares receiving consultant and/or speaker honoraria from Avanir, Boehringer-Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi-Sankyo, Genentech, Janssen, Medtronic, Nestec, Portola, and Pzifer; and royalty payments from Duke University. D.J.A. declares receiving payments as an individual for consulting fees or honoraria from Abbott Vascular, AstraZeneca, Daiichi-Sankyo, Eli Lilly, Merck, PLx Pharma, Sanofi, and The Medicines Company; and for participation in review activities from CeloNova, Johnson & Johnson, and St. Jude Medical; and receiving institutional payments for grants from AstraZeneca, CSL Behring, Daiichi-Sankyo, Eli Lilly, Gilead, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis, Osprey Medical, and The Medicines Company.

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Capodanno, D., Alberts, M. & Angiolillo, D. Antithrombotic therapy for secondary prevention of atherothrombotic events in cerebrovascular disease. Nat Rev Cardiol 13, 609–622 (2016). https://doi.org/10.1038/nrcardio.2016.111

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