Antithrombotic dilemmas in stroke medicine: new data, unsolved challenges

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Antithrombotic therapy is vital for secondary prevention after ischemic stroke or transient ischemic attack.
• Clinical application of antithrombotic agents is complex and requires careful consideration of patient-specific factors.

Purpose of the Study:

• To provide an updated review of challenging scenarios in antithrombotic management.
• To focus on recent clinical trials and observational studies to guide clinical practice.

Main Methods:

• Review of recent clinical trials and large observational studies.
• Discussion of specific clinical situations including intracranial bleeding history, dual antithrombotic therapy, and treatment failure.
• Analysis of anticoagulation timing post-cardioembolic stroke and use in asymptomatic cerebrovascular disease.

Main Results:

• Identified key challenges in antithrombotic management, including managing patients with prior intracranial hemorrhage and those requiring combined anticoagulant and antiplatelet therapy.
• Highlighted uncertainties regarding optimal timing of anticoagulation after cardioembolic stroke and the role of antithrombotics in asymptomatic cerebrovascular disease.
• Emphasized that despite new evidence, several clinical questions remain unresolved.

Conclusions:

• Complex cases in antithrombotic therapy require careful, evidence-based decision-making.
• Ongoing research is crucial to address remaining uncertainties in optimizing antithrombotic treatment for stroke prevention.