Antithrombotic and thrombolytic therapy for ischemic stroke

Antithrombotic and thrombolytic agents form the cornerstone of stroke prevention and treatment. Large, randomized trials also have highlighted the effectiveness and safety of early and continuous antiplatelet therapy in reducing atherothrombotic stroke recurrence. Aspirin has become the antiplatelet treatment standard against which several other antiplatelet agents (i.e., ticlopidine, clopidogrel, aspirin/dipyridamole) have been shown to be more effective. The prevention of cardioembolic stroke, on the other hand, is best accomplished with oral anticoagulation, barring any contraindications. The thrombolytic agent rt-PA improves outcome in patients with ischemic stroke treated within 3 hours of onset. The risk-benefit ratio is narrow due to an increased risk for bleeding, but studies do not support a higher risk in the geriatric population.