The consensus statement  was proposed by the chairpersons in the session, Dr Hans-Göran Hårdemark, Stockholm and Professor Gudrun Boysen, Oslo, together with the speakers in the session. The statement was then finally approved by the participants of the meeting, after listening to the different presentations.

The speakers in this session were Dr Cathie Sudlow, Edinburgh, Professor Luis R. Caplan, Boston, Professor Markku Kaste, Helsinki (presenting for Professor Werner Hacke, Heidelberg, who was unable to participate) and Associate Professor Arne Lindgren, Lund. 

Antiplatelet therapy for stroke prevention

1.  There are no new data from large randomized controlled trials (RCTs) on antiplatelet therapy in stroke/TIA patients that may cause  reconsideration of previous consensus statement at the Karolinska Stroke Update 1998 and 2000 meetings. Existing data have been summarized recently, e.g. by the Antithrombotic Trialist Collaboration and the Cochrane Collaboration. New trials regarding antiplatelet regimens other than aspirin alone are ongoing/planned.

2.  Aspirin 75-150 mg daily is as effective as higher doses in long-term
prevention. It is uncertain whether aspirin doses of < 75 mg daily, although more effective than placebo, are as effective as >= 75 mg daily. However, there may be more pressing issues than the aspirin dose question that need to be addressed e.g. risk factor management.

3.  There are no data from RCTs supporting increased effectiveness of
clopidogrel in certain high-risk stroke/TIA patients. If clopidogrel seems
to be more effective in certain subgroups of stroke patients, as suggested by some post-hoc analyses, then, logically, it will probably be less effective in others.
 
4.  Regarding dipyridamole induced headache there are some pilot data from 57 patients that indicate that dose titration might influence the amount of headache during initiation of dipyridamole therapy. Further studies are required.

This consensus statement was proposed by the chairpersons, Dr Karsten Overgaard, Copenhagen, Denmark and Dr Hans-Göran Hårdemark, Uppsala, Sweden together with the speakers in this session. The statement was then finally approved by the participants of the meeting, after listening to the different presentations.

The speakers in this session were Professor Michael Gent, Hamilton, Canada,  Professor Jaques De Keyser, Groningen, the Netherlands, Associate Professor Arne Lindgren, Lund, Sweden and Dr Georgios Kaponides, Stockholm, Sweden.  

1.       Since the 1998 consensus statement was published no new studies of secondary prevention of stroke using antiplatelet drugs have been published. Therefore it was not considered necessary to revise this text. However, the role of antiplatelet therapy in the acute phase of stroke was not considered in the 1998 document. This issue was addressed in the present statement. Some aspects on dipyridamole related headache were also added.

2.       Antiplatelet treatment in the acute phase of ischaemic stroke: In the acute setting of ischaemic stroke aspirin in a dose of 160-300 mg daily will reduce the risk of non-fatal stroke or death by 10% per 2-4 weeks as compared to placebo (relative risk reduction, 3 studies, grade A evidence).

3.       Results regarding the use of dipyridamole alone or in combination with aspirin or clopidogrel in the acute phase of stroke have not been published.

4.       Dipyridamole treatment: Dipyridamole induced headache appears often to be of vasodilatory type. No published study has yet systematically addressed the question of how to manage dipyridamole associated headache but several methods may be worth considering e.g. starting with a lower dose of dipyridamole or provide concomitant treatment with analgetics during a short initiation period. A study addressing the management of dipyridamole related headache is needed.