Echocardiography (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e393 6.6. Antithrombotic Treatment 6.6.1. Noncardioembolic Stroke COR LOE New, Revised, or Unchanged 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. I A Recommendation reworded for clarity from 2014 Secondary Prevention. COR and LOE unchanged. See Table XCV in online Data Supplement 1 for original wording. For early secondary prevention in patients with noncardioembolic AIS, 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. I C-EO Recommendation reworded for clarity from 2014 Secondary Prevention. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. For patients who have a noncardioembolic AIS while taking aspirin, increasing the dose of aspirin or switching to an alternative antiplatelet agent for additional benefit in secondary stroke prevention is not well established. IIb B-R Recommendation revised from 2014 Secondary Prevention. 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. 