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[Antithrombotic therapy in cerebral infarction]
1Department of Neurology, School of Medicine, Keio University, Tokyo, Japan.
Insights
Antithrombotic therapies for acute cerebral infarction include thrombolysis, anticoagulants, and antiplatelets. Treatment choice depends on lesion type, time, and severity, with aspirin showing slight efficacy.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Context:
- Cerebral infarction, or stroke, necessitates timely antithrombotic interventions.
- Current acute-stage treatments involve thrombolysis, anticoagulation, and antiplatelet agents.
- Treatment selection is guided by clinicopathological factors, onset time, and illness severity.
Purpose:
- To review current antithrombotic therapies for acute cerebral infarction.
- To discuss the efficacy and limitations of various antithrombotic agents.
- To outline strategies for stroke recurrence prevention in the chronic stage.
Summary:
- Tissue plasminogen activator is approved for use within 3 hours of stroke onset in the US.
- Heparin's efficacy in acute cerebral infarction is unproven due to hemorrhagic risks.
- Argatroban (selective thrombin inhibitor) and sodium ozagrel (thromboxane A2 synthetase inhibitor) are used in Japan.
- Low-dose aspirin demonstrates modest efficacy in the acute phase.
- Chronic-stage prevention involves antiplatelet therapy (aspirin, ticlopidine) for atherothrombotic stroke and warfarin for cardioembolic stroke.
Impact:
- Provides a comprehensive overview of antithrombotic strategies for cerebral infarction.
- Highlights the importance of tailored treatment based on stroke subtype and timing.
- Informs clinical decision-making for acute stroke management and secondary prevention.
Abstract:
Antithrombotic therapy for the acute stage of cerebral infarction consists of thrombolysis, anticoagulant therapy and antiplatelet therapy, and their indications depend on the clinicopathological type of lesion, time after onset, and severity of illness. Tissue plasminogen activator has been approved in the United States for use in cerebral infarction within 3 hours after onset. The usefulness of heparin as anticoagulant therapy at the acute stage of cerebral infarction was not proved by the International Stroke Trial due to hemorrhagic complication. A selective thrombin inhibitor (argatroban) is used in Japan for atherothrombotic cerebral infarction within 48 hours after onset. A selective thromboxane A2 synthetase inhibitor (sodium ozagrel) had been approved for cerebral thrombosis within 5 days after onset. Aspirin (160-300 mg/day) is effective, but slightly, in the acute stage of cerebral infarction by the International Stroke Trial and Chinese Acute Stroke Trial. To prevent recurrence of stroke in the chronic stage of cerebral infarction, antiplatelet therapy (with aspirin or ticlopidine) is used for atherothrombotic cerebral infarction, and anticoagulant therapy with warfarin for cardioembolic cerebral infarction.