4.7 Review

Antithrombotic Therapy for Primary and Secondary Prevention of Ischemic Stroke JACC State-of-the-Art Review

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 82, Issue 15, Pages 1538-1557

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2023.07.025

Keywords

anticoagulation; antiplatelet therapy; antithrombotic therapy; prevention; stroke

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This review provides a comprehensive summary of the latest evidence on antithrombotic therapy for ischemic stroke and offers an updated therapeutic algorithm for physicians to tailor the treatment strategy to individual patients.
Stroke is a devastating condition with significant morbidity and mortality worldwide. Antithrombotic therapy plays a crucial role in both primary and secondary prevention of stroke events. Single or dual antiplatelet therapy is generally preferred in cases of large-artery atherosclerosis and small-vessel disease, whereas anticoagulation is recommended in conditions of blood stasis or hypercoagulable states that mostly result in red thrombi. However, the benefit of antithrombotic therapies must be weighed against the increased risk of bleeding, which can pose significant challenges in the pharmacological management of this condition. This review provides a comprehensive summary of the currently available evidence on antithrombotic therapy for ischemic stroke and outlines an updated therapeutic algorithm to support physicians in tailoring the strategy to the individual patient and the underlying mechanism of stroke. (c) 2023 by the American College of Cardiology Foundation.

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