What are the recommended treatments for noncardioembolic AIS?
For patients with noncardioembolic AIS, the use of antiplatelet agents rather than oral anticoagulation is recommended to reduce the risk of recurrent stroke and other cardiovascular events. The selection of an antiplatelet agent should be individualized on the basis of patient risk factor profiles, cost, tolerance, relative known efficacy of the agents, and other clinical characteristics. In patients with a noncardioembolic ischemic stroke, the therapeutic benefit of aspirin is similar across a wide range of doses, but the hemorrhagic risk increases with higher doses. In patients taking aspirin at the time of the incident stroke, the benefit of switching to an alternative antiplatelet agent or combination therapy is not well established. The SPS3 RCT (Secondary Prevention of Small Subcortical Strokes) found no benefit from adding clopidogrel to aspirin compared with placebo in patients with a recent small vessel, lacunar stroke taking aspirin at the time of their index event.