What’s new in stroke? The top 10 studies of 2006–2008. Part I

Ten studies from 2006–2008 that have importantly influenced clinical management of stroke and threatened stroke are presented. In Part I, four randomized clinical trials testing antithrombotic agents for secondary prevention of noncardioembolic ischemic stroke are analyzed. Clopidogrel and extended-release dipyridamole/low-dose aspirin in patients with recent ischemic stroke are shown to be about equal for reducing recurrent stroke in the giant international PRoFESS trial. Combination antiplatelet therapy with clopidogrel plus aspirin is not better than either alone for prevention of vascular events and causes more serious bleeding based on the CHARISMA trial. Extended-release dipyridamole/low-dose aspirin is better than low-dose aspirin alone for secondary stroke prevention from ESPRIT. Based on the second component of ESPRIT, aspirin is as good as anticoagulation after noncardioembolic brain ischemia. These trials, together involving 39,742 participants, have influenced 2008 European and North American guidelines for secondary prevention of noncardioembolic stroke, and these guideline recommendations are reviewed.