Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease: JACC Scientific Expert Panel

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Stroke survivors face a significant risk of recurrence, necessitating effective secondary prevention strategies.
• Antithrombotic medications are critical for reducing the overall burden of stroke.

Purpose of the Study:

• To review recent clinical trials and evidence-based recommendations for antithrombotic agent selection in secondary stroke prevention.
• To highlight current evidence gaps and ongoing research in the field.

Main Methods:

• Review of large randomized controlled trials, systematic reviews, and meta-analyses.
• Analysis of evidence-based recommendations derived from landmark trials.
• Identification of recent trials impacting clinical practice.

Main Results:

• Antiplatelet therapy is recommended for atherosclerotic and endothelial injury-related lesions.
• Anticoagulant agents are favored for cardiogenic embolism and hypercoagulable states.
• Recent trials have refined recommendations for antiplatelet and anticoagulant use post-stroke.

Conclusions:

• Appropriate antithrombotic selection is guided by the specific physiopathological mechanism of ischemic injury.
• Evidence-based guidelines support the use of antiplatelet and anticoagulant agents for secondary stroke prevention.
• Ongoing research and identified evidence gaps will further shape future clinical practice.