Antiplatelet Therapy in Cerebral Small Vessel Disease

  • Danielle de sa Bouasquevisque
  • Oscar R. Benavente
  • Ashkan ShoamaneshEmail author
Stroke (H.C. Diener, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke


Purpose of Review

We critically evaluate the evidence for the use of antiplatelet therapy for stroke prevention following lacunar stroke and in patients with hemorrhage-prone cerebral small vessel disease.

Recent Findings

Pooled lacunar stroke subgroup analyses of all relevant randomized controlled trials to date suggest a 22% relative risk reduction in recurrent stroke by single antiplatelet therapy (RR 0.77, 95% CI 0.62–0.97) compared with placebo, no consistent suggestion of variable efficacy amongst specific antiplatelet agents, and the absence of clear benefit with dual over single antiplatelet therapy. Current data does not support withholding antiplatelet therapy where otherwise indicated in patients with cerebral microbleeds on MRI or those who have suffered intracerebral hemorrhage.


Antiplatelet monotherapy appears to provide persistent secondary stroke prevention in patients with lacunar stroke. Whether phosphodiesterase inhibitors, particularly cilostazol, provide additional advantage in patients with cerebral small vessel disease is worthy of further investigation.


Lacunar stroke Antiplatelet Antithrombotic Cerebral small vessel disease Microbleed Intracerebral hemorrhage 


Compliance with Ethical Standards

Conflict of Interest

Danielle de sa Bouasquevisque, Oscar R. Benavente, and Ashkan Shoamanesh each declare no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Danielle de sa Bouasquevisque
    • 1
  • Oscar R. Benavente
    • 2
  • Ashkan Shoamanesh
    • 1
    Email author
  1. 1.Marta and Owen Boris Chair in Stroke Research and Care, Hemorrhagic Stroke Research Program, C4-118, David Braley Cardiac, Vascular and Stroke Research InstituteMcMaster University/Population Health Research InstituteHamiltonCanada
  2. 2.Division of NeurologyUniversity of British ColumbiaVancouverCanada

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