J Korean Med Assoc.  2009 Apr;52(4):356-364. 10.5124/jkma.2009.52.4.356.

Antithrombotic and Neuroprotective Therapy in Acute Ischemic Stroke

• Heo SH
• Chang DI

• KMID: 2137720
• DOI: http://doi.org/10.5124/jkma.2009.52.4.356

Abstract

As, until now, many studies have failed to establish the clinical effect of numerous neuroprotectives, antithrombotic therapy must be emphasized as one of critical options among limited treatment strategies in acute ischemic stroke. Based on the accumulating evidences that platelets and coagulating proteins play an important role in the thrombus formation, antiplatelets and anticoagulants are served as antithrombotics. Recently, major advances have been made in understanding the effects of antiplatelets and anticoagulants. Large randomized clinical trials have highlighted the effectiveness and safety of early and continuous antiplatelet therapy in reducing atherothrombotic stroke recurrence. Urgent anticoagulation has been used often to prevent early recurrent stroke and to improve neurological outcomes, however, its formal use in acute stroke has been the subject of debate even in cardioembolic stroke. That's because anticoagulants also increase the risk of fatal or disabling intracranial hemorrhage and it is difficult to monitor proper anticoagulation. Although early administration of anticoagulants should be considered to prevent the secondary injury and the propagation of thrombosis in patients with atherothrombotic stroke, more evidences are needed especially in patients with infractions secondary to large artery thrombosis or cardioembolism. This review discusses recent advances related to antithrombotic strategies and putative neuroprotectives.

Keyword

Acute stroke; Antithrombotic therapy; Antiplatelet; Anticoagulant; Neuroprotective

MeSH Terms

Anticoagulants
Arteries
Blood Platelets
Humans
Intracranial Hemorrhages
Organothiophosphorus Compounds
Proteins
Recurrence
Stroke
Thrombosis
Anticoagulants
Organothiophosphorus Compounds
Proteins

Figure

• 

  Figure 1 Absolute effects in CAST and IST of early use of aspirin in 40,000 randomized patients with suspected acute ischemic stroke. Numbers and percentages of patients with various outcomes during the scheduled treatment period, by allocated treatment: A indicates aspirin; C, control. The percentages are plotted as bars (with the SD of each bar plotted at the top). The difference between aspirin and control is given as the benefit per 1,000, along with its SD and statistical significance (2P). A negative benefit indicates an apparent hazard. *Number of patients who experienced the relevant event and survived (Stroke 2000; 31: 1240-1249).

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