Medical Therapy for Stroke Prevention in the Older Patient: What to Do When Aspirin Isn’t Enough

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at

L. Creed Pettigrew, MD, MPH, Professor of Neurology, Director, Stroke Program, Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY, USA.

Stroke is the most common life-threatening neurological disease and is the fourth leading cause of death among adult Canadians. Aspirin is the most frequently prescribed antithrombotic drug to prevent stroke but may not be a suitable choice in older patients who have already had stroke symptoms despite its use, or cannot tolerate its side effects. For these patients, clopidogrel or the combination of low-dose aspirin with extended release (ER) dipyridamole should be considered for prevention of stroke. This review will compare the relative benefits of aspirin, clopidogrel, and low-dose aspirin/ER-dipyridamole in geriatric patients at risk for stroke.

Key words: stroke, myocardial infarction, aspirin, clopidogrel, dipyridamole.