What is the typical secondary prevention regimen for noncardioembolic ischemic stroke?

• A. Antiplatelet therapy (aspirin or aspirin plus clopidogrel short-term) and high-intensity statin; risk factor modification.
• B. Anticoagulation with warfarin.
• C. Thrombolysis repeated every day.
• D. No pharmacologic prevention.

Answer: (A)

The main idea is to prevent a recurrent stroke by targeting the mechanism most often involved in noncardioembolic events—platelet-driven thrombosis—and by reducing overall vascular risk. Antiplatelet therapy is central: aspirin alone is commonly used, and in some patients a short period of dual antiplatelet therapy with aspirin plus clopidogrel can lower early recurrence after a minor stroke or high-risk TIA, but the combination is not kept long-term due to bleeding risk. Pair this with a high-intensity statin to aggressively lower LDL and stabilize atherosclerotic disease, which lowers the chance of another event. Equally important is comprehensive risk-factor modification—controlling blood pressure, managing diabetes, quitting smoking, maintaining a healthy weight, and staying physically active. Anticoagulation with warfarin isn’t favored for noncardioembolic stroke because it hasn’t shown a net benefit over antiplatelets and carries more bleeding risk, and repeated thrombolysis isn’t a preventive strategy. Doing nothing pharmacologically would miss these proven protective measures.