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Updated: May 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
[Antiplatelet and anticoagulation therapy in acute cerebral infarction]
1Department of Neurology, Keio University School of Medicine.
Insights
Dual antiplatelet therapy (DAPT) effectively prevents stroke recurrence in acute cerebral infarction by stabilizing plaques. New oral anticoagulants (NOACs) offer safe and effective prevention for atrial fibrillation patients.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Context:
- Atherothrombosis is a key cause of artery territory and watershed cerebral infarctions.
- Hemodynamic instability can lead to microembolism from ruptured plaques in watershed areas.
- Effective treatments for acute cerebral infarction are emerging based on pathophysiology.
Purpose:
- To review recent advancements in treating acute cerebral infarction.
- To highlight the role of dual antiplatelet therapy (DAPT) in atherothrombotic stroke.
- To discuss the use of new oral anticoagulants (NOACs) for cardioembolic stroke prevention.
Summary:
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 21 days shows superior efficacy over aspirin monotherapy in preventing stroke recurrence after acute atherothrombotic events, without increasing hemorrhage risk.
- New oral anticoagulants (NOACs) provide immediate, effective, and safe anticoagulation for atrial fibrillation patients, particularly when the risk of hemorrhagic transformation is low.
- Short-term DAPT in the acute phase is poised to become a standard treatment for acute atherothrombosis.
Impact:
- Short-term DAPT may become a standard treatment for acute atherothrombosis, improving patient outcomes.
- NOACs offer a beneficial alternative for cardioembolic stroke prevention in atrial fibrillation.
- These advancements underscore a shift towards pathophysiology-guided treatments for acute cerebrovascular events.
Abstract:
Effective treatments have recently been developed for acute cerebral infarction based on the pathophysiology.In atherothrombosis, artery-to-artery thrombosis plays a pivotal role in artery territory infarction and even in watershed infarction. In the latter, hemodynamic insufficiency is thought to prompt microembolism from the plaque in the area of borderzone of pial arteries. To suppress development of platelet thrombus on the ruptured plaque, strong antiplatelet therapy is required until the plaque stabilizes. Clinically dual antiplatelet therapy (DAPT) was reported to be more effective than mono therapy in suppressing microembolic signal in the middle cerebral artery. In addition, recent CHANCE trial reported that DAPT with aspirin and clopidogrel for the first 21 days is more effective in suppressing stroke recurrence than aspirin alone. Risk of cerebral hemorrhage was not enhanced in the DAPT group. Short term DAPT in the acute phase may soon be a standard treatment for acute atherothrombosis.For prevention of cardioembolism in patients with atrial fibrillation, new oral anticoagulants (NOAC) have recently been introduced. In cases where risk of hemorrhagic transformation is minimal, immediate anticoagulation with NOAC may provide clinical benefit including prompt anticoagulant effect, no need for drug dosing, and low risk of intracerebral hemorrhage.
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