Early Antithrombotic Therapy in Acute Ischemic Stroke.

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Antithrombotic therapy is vital for preventing recurrent ischemic strokes.
• Aspirin is established for secondary stroke prevention, with early initiation improving outcomes.
• Various antiplatelet agents and anticoagulants are used depending on stroke type and patient factors.

Purpose of the Study:

• To review the current landscape of antithrombotic therapies for acute ischemic stroke.
• To highlight the role of aspirin and dual antiplatelet therapy (DAPT).
• To discuss alternative treatments and considerations for specific stroke etiologies.

Main Methods:

• Systematic review of clinical trials and meta-analyses.
• Analysis of guidelines and real-world data on antiplatelet and anticoagulant use.
• Evaluation of drug efficacy, safety, and specific indications in ischemic stroke.

Main Results:

• Early aspirin initiation (160-300 mg/day within 48 hours) reduces death or dependency.
• Dual antiplatelet therapy (aspirin and clopidogrel) is effective for 21 days to 3 months post-stroke.
• Extended DAPT may increase bleeding risks; prasugrel shows potential but lacks extensive real-world data.
• Antiplatelets may worsen hemorrhagic events in cardioembolic stroke; DOACs and warfarin are used for specific conditions.

Conclusions:

• Aspirin remains a cornerstone for secondary ischemic stroke prevention.
• DAPT offers short-term benefits but requires careful risk-benefit assessment.
• Treatment selection must be individualized based on stroke type, comorbidities, and bleeding risk.