The efficacy and safety of antithrombotic drug options in acute ischemic stroke

INTRODUCTION: Acute ischemic stroke (AIS) is currently the leading cause of morbidity and mortality globally, and despite progress that has been made in treatment and prevention over the last 30 years, its burden is expected to increase in future decades, due to the growth and aging of the populations. Therein, a greater access and delivery of safe and effective better drugs will be needed to improve AIS management. AREAS COVERED: This review highlights the current AIS care strategies, focusing on the efficacy and safety of antithrombotic drugs. EXPERT OPINION: Regarding AIS, reperfusion through IV thrombolysis remains the cornerstone of treatment, alongside mechanical thrombectomy in eligible patients. International guidelines recommend Alteplase within 4.5 hours of symptom onset; however, advanced neuroimaging may allow for the extension of this treatment window in selected patients. Tenecteplase, with its favorable pharmacokinetics and simplified administration, is emerging as an alternative. Early secondary prevention is strictly dependent on stroke etiology and consists of antiplatelets, oral anticoagulants, and aggressive risk factor control. Cardioembolic strokes require timely oral anticoagulation, while noncardioembolic minor ischemic strokes or high-risk transient ischemic attacks benefit from short-term dual antiplatelet therapy.