Acute Antithrombotic Treatment of Ischemic Stroke

Abstract

Antithrombotic medication is a cornerstone of acute ischemic stroke treatment and secondary prevention. The efficacy of thrombolysis with alteplase in acute stroke has been demonstrated in several clinical trials. This safe and costeffective therapy has transformed the practice of stroke care and has led to subsequent trials of other antithrombotic medications for treatment of ischemic stroke in the acute phase. These antithrombotics include thrombolytic, antiplatelet and anticoagulant agents. While, no other medication has yet demonstrated adequate efficacy, our current and evolving understanding of infarct expansion, ischemic penumbra, collateral circulation and the blood brain barrier is allowing testing of antithrombotic medications tailored to individual patient pathophysiology in clinical trials. This understanding accompanies developments in neuroimaging and organization of stroke care that allow for wide-spread recruitment in these trials. Alteplase remains the mainstay treatment of arterial acute ischemic stroke; however, anticoagulation is the standard therapy for cerebral venous sinus thrombosis. Antithrombotic use in acute stroke, arterial and venous, has demonstrated efficacy but leaves many questions unanswered. This patient population is a fertile ground for novel research, especially as it relates to; combination antithrombotic therapy, combination of pharmacological and mechanical thrombolysis, and the transition to secondary prevention. Here we review the current antithrombotics in the acute phase of ischemic stroke highlighting the evidence-base and areas of uncertainty.

Effects of Urinary Kallidinogenase on NIHSS score, mRS score, and fasting glucose levels in acute ischemic stroke patients with abnormal glucose metabolism

“…Antithrombotic treatment is an important part of current treatment of acute ischemic stroke (AIS). [17,18] During onset of AIS, irreversible ischemia and hypoxic necrosis occur in the central area of the infarct lesion because of a reduced or interrupted blood supply. However, there are many surviving neurons in the ischemic penumbra of the marginal zone, which can restore their normal function if blood perfusion is recovered in a short time.…”

Clinical features and biological markers of lung cancer-associated stroke

“…[1][2][3] Ischemic stroke is the most common type of stroke, and its management and treatment differ from those of haemorrhagic stroke. 4,5 Risk factors associated with ischaemic stroke include high blood pressure, obesity and diabetes mellitus, which require different management strategies. 6,7 Cancer is a leading cause of death in both more and less economically developed countries.…”

Pharmacological therapy of acute ischaemic stroke: Achievements and problems

“…Among the cyclooxygenase inhibitors, oral acetylsalicylic acid administration as monotherapy within 24 to 48 h after stroke onset is recommended in most patients, although not as a substitute for rtPA and not as an adjunctive therapy (Jauch et al, 2013; Cochrane review by Sandercock et al, 2014). The high stroke incidence worldwide and ineligibility of many patients to thrombolysis make aspirin a fundamental therapy for AIS (Alderazi and Grotta, 2014). Dual antiplatelet treatments of aspirin and drugs with different mechanisms such as cyclic nucleotide phosphodiesterase inhibitors (dipyridamole, cilostazol) and purinergic receptors P2Y antagonists (clopidogrel) are also safe and effective in reducing stroke recurrence (Geeganage et al, 2012;Bhogal et al, 2014).…”