Antiplatelet therapy is one of the mainstays for secondary stroke prevention. This narrative review aimed to highlight the current evidence and recommendations of antiplatelet therapy for stroke prevention. We conducted advanced literature search for antiplatelet therapy. Landmark studies and randomised controlled trials evaluating antiplatelet therapy for secondary stroke prevention are reviewed. Results from Cochrane systematic review, pooled data analysis and meta-analysis are discussed. Single-antiplatelet therapy (SAPT) with aspirin, aspirin/extended-release dipyridamole or clopidogrel reduces the risk of recurrent ischaemic stroke in patients with non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA). Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or ticagrelor for 21–30 days is more effective than SAPT in patients with minor acute noncardioembolic ischaemic stroke or high-risk TIA. Prolonged use of DAPT is associated with higher risk of haemorrhage without reduction in stroke recurrence than SAPT. Compared with placebo, aspirin reduces the relative risk of recurrent stroke by approximately 22%. Aspirin/dipyridamole and cilostazol are superior to aspirin but associated with significant side effects. Cilostazol or ticagrelor might be more effective than aspirin or clopidogrel in patients with intracranial stenosis. SAPT is indicated for secondary stroke prevention in patients with non-cardioembolic ischaemic stroke or TIA. DAPT with aspirin and clopidogrel or ticagrelor for 21–30 days followed by SAPT is recommended for patients with minor acute noncardioembolic stroke or high-risk TIA. Selection of appropriate antiplatelet therapy should also be based on compliance, drug tolerance or resistance.

Background: Language barriers were reported to affect timely access to health care and outcome. The aim of this study was to investigate the effect of language disparity on quality benchmarks of acute ischemic stroke therapy. Methods: Consecutive patients with acute ischemic stroke at the University of California Irvine Medical Center from 2013 to 2016 were studied. Patients were categorized into 3 groups according to their preferred language: English, Spanish, and other languages. Quality benchmarks and outcomes of the 3 language groups were analyzed. Results: Of the 928 admissions, 69.7% patients recorded English as preferred language, as compared to 17.3% Spanish and 13.0% other languages. There was no significant difference in the rate of receiving intravenous thrombolysis (24.3, 22.1 and 21.0%), last-known-well to door time, door-to-imaging time, door-to-needle time, and hospital length of stay among the 3 language groups. In univariate analysis, the other languages group had lower chance of favorable outcomes than the English-speaking group (26.3% vs 40.4, p < 0.05) while the Spanish-speaking group had lower mortality rate than English-speaking group (3.1% vs 7.7%, p = 0.05). After adjusting for age and initial NIHSS scores, multivariate regression models showed no significant difference in favorable outcomes and mortality between different language groups. Conclusion: We demonstrate no significant difference in quality benchmarks and outcome of acute ischemic stroke among 3 different language groups. Our results suggest that limited English proficiency is not a significant barrier for time-sensitive stroke care at Comprehensive Stroke Center.

Background: Methamphetamine use has emerged as a major risk factor for cardiovascular and cerebrovascular disease in young adults. The aim of this study was to investigate a possible association of methamphetamine use with cardioembolic stroke. Methods and Results: We performed a retrospective study of patients with acute ischemic stroke admitted at our medical center between 2019 and 2022. All patients were screened for methamphetamine use and cardiomyopathy, defined as left ventricular ejection fraction ≤45%. Among 938 consecutive patients, 46 (4.9%) were identified as using methamphetamine. Compared with the nonmethamphetamine group (n=892), the methamphetamine group was significantly younger (52.8±9.6 versus 69.7±15.2 years; P <0.001), included more men (78.3% versus 52.8%; P <0.001), and had a significantly higher rate of cardiomyopathy (30.4% versus 14.0%; P <0.01). They were also less likely to have a history of atrial fibrillation (8.7% versus 33.4%; P <0.01) or hyperlipidemia (28.3% versus 51.7%; P <0.01). Compared with patients with cardiomyopathy without methamphetamine use, the patients with cardiomyopathy with methamphetamine use had significantly lower left ventricular ejection fraction (26.0±9.59% versus 32.47±9.52%; P <0.01) but better functional outcome at 3 months, likely attributable to significantly younger age and fewer comorbidities. In the logistic regression model of clinical variables, methamphetamine‐associated cardiomyopathy was found to be significantly associated with cardioembolic stroke (odds ratio, 1.79 [95% CI, 1.04–3.06]; P <0.05). Conclusions: We demonstrate that methamphetamine use is significantly associated with cardiomyopathy and cardioembolic stroke in young adults.

Aim: To describe the potential role of thromboinflammation in thromboembolism and the progress of coronavirus disease 2019 (COVID-19). Methods: The retrospective study included sequentially hospitalized patients with the diagnosis of COVID-19 pneumonia during the first pandemic (December 1, 2022, to January 31, 2023) at a medical center in Beijing, China. Risks of critical medical support requirements, thrombosis events, and death were valued in the multivariate logistic regression models, where age (≥ 80 vs. < 80 years old), nadir platelets level (≤100 vs. > 100 10^9/L), C-reactive protein (CRP) level at admission (≥ 80 vs. < 80 mg/L), D-dimer level at admission (≥ 1.0 vs. < 1.0 mg/L) were dichotomized. Results: A total of 88 patients were included (median age 77 years, 72% male). During hospitalization, 35 (40%) patients required critical medical support, 22 (29%) had disseminated intravascular coagulation (DIC), 11 (13%) had radiologically supported thrombosis events, and 26 (30%) died. Increased age (odds ratio [OR]: 5.22,95% confidence interval [CI]: 1.27-21.53; p =0.02), elevated CRP levels (OR: 9.26, 95% CI: 2.24-38.37; p <0.01), decreased nadir platelet level (OR: 13.47, 95% CI: 1.91-94.84; p <0.01), elevated D-dimer level (OR: 5.21, 95 CI%: 0.96-28.21; p =0.06) were associated with the requirements of critical care. Increased age (OR: 10.87, 95% CI: 3.05-38.80; p <0.01), elevated CRP levels (OR: 6.14, 95% CI:1.68-22.47; p <0.01), decreased nadir platelet levels (OR: 5.96, 95% CI: 1.34-26.47; p =0.02) and D-dimers (≥1.0 vs. <1.0 mg/L, OR: 2.26, 95% CI: 0.68-7.44; p =0.18) were associated with death. Increased age (OR: 2.40,95% CI: 0.60-9.67; p =0.22), decreased nadir platelet levels (OR: 1.31, 95% CI: 0.22-7.96; p =0.77), inflmmation status, including D-dimers (≥1.0 vs. <1.0 mg/L, OR:4.62, 95% CI: 0.89-24.04; p =0.07) and CRP (≥80 vs. <80 mg/mL, OR:5.44, 95% CI: 1.05-28.27; p =0.04) were significantly associated with the risks of thromboembolism. Conclusions: The retrospective study indicated thromboinflammation promoted thromboembolism and was associated with the outcomes of COVID-19 pneumonia.