Acute Antithrombotic Therapy

The pathogenesis of acute ischemic stroke involves thrombotic mechanisms that provide a potential target for directed pharmacotherapy. Acute antithrombotic therapy, including antiplatelet agents as well as anticoagulants, can target these pathways early on after ischemic stroke, when the risks of recurrent ischemic stroke are highest. Most secondary prevention studies of antithrombotic agents exclude this early period, so data from acute studies of aspirin therapy and short-term dual-antiplatelet therapy with clopidogrel-aspirin and ticagrelor-aspirin are required to balance early benefits and risks. In contrast, anticoagulation is generally avoided acutely out of a concern for early hemorrhagic transformation, particularly when the ischemic stroke burden is large, and even when chronic anticoagulation would ultimately be indicated over the long-term.