2026/11/15 13:30-15:00 Room 401
- CME
- Time
- Topic
- Speaker
- Moderator
- 14:00-14:30
- 抗血栓藥物與中風次級預防 Antithrombotic Therapy for Secondary Stroke Prevention
- SPEAKER:
WEN-YU OU YANG
歐陽彣昱
Taiwan (台灣)
- MODERATOR:
Hung-Yu Huang
黃虹瑜
Taiwan (台灣)
- WEN-YU OU YANG
- MD
-
Fellow doctor, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
E-mail：urania41228@gmail.com
Lecture Abstract：
Recurrent ischemic stroke remains a major cause of disability and mortality, and antithrombotic therapy is central to secondary prevention. However, the optimal regimen depends on the underlying stroke mechanism and must balance protection from recurrent ischemia against intracranial and extracranial bleeding. This lecture will provide a practical, mechanism-based review of antiplatelet and anticoagulant strategies after ischemic stroke or transient ischemic attack.
For non-cardioembolic stroke caused by large-artery atherosclerosis or small-vessel disease, antiplatelet therapy remains the foundation of treatment. Short-term dual antiplatelet therapy with aspirin and clopidogrel is most beneficial when initiated early after minor ischemic stroke or high-risk transient ischemic attack, particularly in symptomatic intracranial atherosclerotic disease, whereas prolonged dual therapy generally adds bleeding risk without further ischemic benefit. Aspirin, clopidogrel, aspirin-dipyridamole, ticagrelor-based therapy, and cilostazol will be discussed with attention to patient selection, treatment duration, vascular interventions, pharmacogenetic considerations, and evidence relevant to Asian populations.
For cardioembolic stroke associated with atrial fibrillation, oral anticoagulation is preferred; direct oral anticoagulants are generally favored in nonvalvular atrial fibrillation, while vitamin K antagonists remain indicated for mechanical valves and rheumatic mitral stenosis. The timing of anticoagulation after acute stroke should be individualized according to infarct size, hemorrhagic transformation, and bleeding risk. Empirical anticoagulation is not supported for unselected embolic stroke of undetermined source, for which further etiologic investigation and antiplatelet therapy remain appropriate.
By integrating stroke etiology, vascular imaging, cardiac evaluation, comorbidities and bleeding risk, this lecture aims to translate current evidence into individualized antithrombotic decisions for everyday clinical practice.
Recurrent ischemic stroke remains a major cause of disability and mortality, and antithrombotic therapy is central to secondary prevention. However, the optimal regimen depends on the underlying stroke mechanism and must balance protection from recurrent ischemia against intracranial and extracranial bleeding. This lecture will provide a practical, mechanism-based review of antiplatelet and anticoagulant strategies after ischemic stroke or transient ischemic attack.
For non-cardioembolic stroke caused by large-artery atherosclerosis or small-vessel disease, antiplatelet therapy remains the foundation of treatment. Short-term dual antiplatelet therapy with aspirin and clopidogrel is most beneficial when initiated early after minor ischemic stroke or high-risk transient ischemic attack, particularly in symptomatic intracranial atherosclerotic disease, whereas prolonged dual therapy generally adds bleeding risk without further ischemic benefit. Aspirin, clopidogrel, aspirin-dipyridamole, ticagrelor-based therapy, and cilostazol will be discussed with attention to patient selection, treatment duration, vascular interventions, pharmacogenetic considerations, and evidence relevant to Asian populations.
For cardioembolic stroke associated with atrial fibrillation, oral anticoagulation is preferred; direct oral anticoagulants are generally favored in nonvalvular atrial fibrillation, while vitamin K antagonists remain indicated for mechanical valves and rheumatic mitral stenosis. The timing of anticoagulation after acute stroke should be individualized according to infarct size, hemorrhagic transformation, and bleeding risk. Empirical anticoagulation is not supported for unselected embolic stroke of undetermined source, for which further etiologic investigation and antiplatelet therapy remain appropriate.
By integrating stroke etiology, vascular imaging, cardiac evaluation, comorbidities and bleeding risk, this lecture aims to translate current evidence into individualized antithrombotic decisions for everyday clinical practice.
