Optimizing Thrombolysis for Acute Ischemic Stroke: Adjunct Therapies and Multiple Dosing Strategies

Area of Science:

• Neurology
• Cardiovascular Medicine
• Pharmacology

Background:

• Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are primary treatments for acute ischemic stroke, targeting different occlusion types.
• Current therapies frequently fail to achieve sustained recanalization, microvascular reperfusion, and optimal patient outcomes.
• Adjunctive antithrombotic therapies and alternative lytics like tenecteplase offer limited improvements over standard alteplase.

Purpose of the Study:

• To review current evidence on multiple dosing strategies for IVT in acute ischemic stroke.
• To explore the combination of IVT with EVT and the use of intra-arterial thrombolytics.
• To discuss the rationale, clinical trial results, and future research directions for enhanced thrombolytic approaches.

Main Methods:

• Systematic review of existing clinical trials and pharmacokinetic/physiologic data.
• Analysis of studies investigating repeat IVT administration in non-EVT candidates.
• Evaluation of trials combining IVT or intra-arterial thrombolytics with EVT.

Main Results:

• Emerging data suggest that novel fibrinolytic agents and sequential IVT dosing can improve reperfusion.
• Adjunct intra-arterial thrombolysis in combination with EVT shows potential for enhanced outcomes.
• These strategies aim to improve functional recovery while maintaining a favorable safety profile.

Conclusions:

• Multiple dosing strategies for IVT and combination therapies with EVT represent promising avenues for improving acute ischemic stroke treatment.
• Further research is needed to optimize these novel approaches for enhanced reperfusion and patient recovery.
• Novel fibrinolytic agents and sequential thrombolysis hold potential for advancing stroke care.