Korean J Clin Pharm.  2024 Jun;34(2):79-99. 10.24304/kjcp.2024.34.2.79.

Review of Updated Guidelines and Evidence for Antithrombotic Therapy in Acute Ischemic Stroke

• Paik SH

• KMID: 2564363
• DOI: http://doi.org/10.24304/kjcp.2024.34.2.79

Abstract

Background
There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision.
Methods
The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy during acute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines.
Results
The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered in highly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that it may be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation.
Conclusions
It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

Keyword

Acute ischemic stroke; Anticoagulants; Antiplatelets; Antithrombotic therapy; Dual antiplatelet therapy; Korean clinical practice guideline for stroke