Evolving Approaches to Antithrombotics in Stroke Prevention and Treatment

Vijayakumar Javalkar, MD, MCh; Okkes Kuybu, MD; Abdallah Amireh, MD; Roger E. Kelley, MD


South Med J. 2020;113(11):585-592. 

In This Article


The optimization of antithrombotic therapy for acute stroke treatment and secondary prevention remains in the process of refinement; however, options have improved dramatically with the release of the NOACs and the results of RCTs to assess potential benefits versus potential risks for our patients in an individualized fashion. It is particularly valuable to have options for our patients when the initial choice of therapy does not demonstrate benefit or is not well tolerated. Recent studies, for example, have supported the benefit and relative safety of short-term DAPT has for minor stroke and TIA but not for triple therapy. Alternative choices such as cilostazol and possibly ticagrelor for refractory patients also may help in the decision-making process. Table 4 summarizes pertinent information from recent antithrombotic therapies in stroke and TIA trials.