OPPORTUNITIES AND CHALLENGES IN THE USE OF COMBINATION ANTIPLATELET AND ANTICOAGULANT THERAPY FOR SECONDARY STROKE PREVENTION

Abstract

The aim of this review is to summarize current evidence and identify potential settings for the use
of combination therapy with low-dose rivaroxaban and aspirin in patients with history of previous
stroke. Combined therapy with low-dose rivaroxaban and aspirin seems to be superior in both primary
and secondary stroke prevention for patients with history of coronary artery disease or peripheral artery
disease. There are several settings in secondary stroke prevention where the combined therapy of low-
dose rivaroxaban and aspirin might be a preferred option, including a history of coronary artery disease,
peripheral artery disease, complex aortic atherosclerosis, extracranial and intracranial large vessel disease
and after carotid revascularization procedures. As questions on the optimal management of patients on
combination therapy in the acute stroke setting will arise, we propose an algorithm for treatment decisions
for patients receiving combination of low-dose rivaroxaban and aspirin presenting within 4.5 hours from symptom onset.