Recurrent stroke is a frequent event and clinical trials that addressed the best secondary
prevention are sparse. If patients take a thrombocyte aggregation inhibitor (TAI)
before the recurrent stroke, clopidogrel can be chosen instead of aspirin or vice
versa but evidence is lacking. A 3-week period of dual antiplatelet treatment might
be a good alternative after acute reinfarction. The results of the recently published
RESTART trial support resuming TAI treatment after a hemorrhagic stroke and showed
that the intracerebral hemorrhage (ICH) rate is not elevated in comparison with a
study group without TAI. Patients with ICH associated with oral anticoagulation (OAC)
and atrial fibrillation should be restarted on novel OACs, if there are no relevant
contraindications and the risk of ischemia is high. The anticoagulation treatment
of patients with cerebral amyloid angiopathy is still a clinical dilemma as there
is a high risk of recurrent ICH. These patients might be candidates for left appendage
closure.
