New Drugs and Interventions for Stroke Patients

Stroke is the second leading cause of mortality and the third leading cause of disability globally. Given its great incidence, and its devastating consequences, stroke is a principal field of medical research. Hence, research has focused on the development of new drugs for primary stroke prevention, management during the acute phase of stroke, and prevention of recurrent stroke. Inhibitors of the activated coagulation factor XI (FXIa), including asundexian (BAY 2433334) and abelacimab (MAA868) have emerged as promising anticoagulant agents for primary stroke prevention in patients with atrial fibrillation, as well as for secondary stroke prevention. Regarding the management during the acute phase of ischemic stroke, accumulating evidence from recent randomized clinical trials (RCTs) led the European Stroke Organization to publish new guidelines in 2023, recommending tenecteplase for acute ischemic stroke intravenous thrombectomy. Other thrombolytic molecules such as “Stachybotrys microspore triprenyl phenol-7” (SMTP-7), desmoteplase, staphylokinase, and glenzocimab (ACT017) are also under investigation. Except for FXIa, ongoing RCTs investigate the role of new antiplatelet agents such as vorapaxar, a new platelet thrombin protease-activated receptor 1 blocker, in secondary prevention of ischemic stroke. Finally, current research is aiming to develop antidotes for the new anticoagulants, as rapid, safe, and durable reverse of the anticoagulant effect is mandatory in emergency situations. Such antidotes include idarucizumab, andexanet, aripazine, and ciraparantag.