From the Guidelines
The cornerstone treatment post ischemic stroke is intravenous recombinant tissue plasminogen activator (r-tPA) if treatment can be initiated within 3 hours of symptom onset, followed by antiplatelet therapy, typically starting with aspirin at a dose of 160-325mg immediately after stroke diagnosis, as recommended by 1. This approach works by dissolving the blood clot causing the stroke and preventing the formation of new blood clots by inhibiting platelet aggregation, thereby reducing the risk of recurrent stroke. Key points to consider in the management of ischemic stroke include:
- Urgent evaluation and treatment, with a focus on determining eligibility for thrombolytic therapy with r-tPA, as outlined in 1
- Blood pressure management, targeting <140/90 mmHg, as recommended by 1
- Statin therapy, such as atorvastatin 40-80mg daily, for cholesterol reduction
- Lifestyle modifications, including smoking cessation, limited alcohol intake, regular physical activity, and a Mediterranean or DASH diet, as emphasized in 1
- Early rehabilitation, beginning within 24-48 hours of stroke if the patient is stable, and including physical, occupational, and speech therapy as needed For patients with atrial fibrillation, anticoagulation with direct oral anticoagulants (DOACs) or warfarin is recommended instead of antiplatelet therapy to prevent cardioembolic strokes, as suggested by 1. Overall, a comprehensive approach to ischemic stroke management, incorporating these evidence-based recommendations, can help reduce morbidity, mortality, and improve quality of life for patients.
From the Research
Cornerstone Treatment Post Ischemic Stroke
The cornerstone treatment for post ischemic stroke involves several key components, including:
- Thrombolysis with alteplase, which has been shown to improve clinical outcomes in patients with acute ischemic stroke 2, 3, 4
- Antithrombotic medication, which is a cornerstone of acute ischemic stroke treatment and secondary prevention 3
- Early administration of treatment, which improves functional outcome and depends on the time elapsed between stroke onset and initiation of treatment 4
Treatment Options
Treatment options for post ischemic stroke include:
- Intravenous thrombolysis with alteplase, which is the primary therapy for acute ischemic stroke and is approved in most countries 2, 4
- Intra-arterial thrombolysis, which has a less extensive evidence base and is mostly unapproved for acute stroke 4
- Anti-platelet therapy, which may be used in combination with thrombolysis to reduce the risk of vessel reocclusion 5
- Endovascular therapy, which is a treatment option for acute ischemic stroke and may be used in combination with thrombolysis 6
Safety and Efficacy
The safety and efficacy of these treatment options have been studied in several clinical trials, including:
- A study that demonstrated the efficacy and safety of alteplase administered between 3 and 4.5 hours after the onset of symptoms 2
- A study that reviewed the current antithrombotics in the acute phase of ischemic stroke and highlighted the evidence-base and areas of uncertainty 3
- A study that demonstrated the benefit of intravenous thrombolysis when initiated up to 4.5 hours after symptom onset 4
- A meta-analysis that evaluated the safety and effectiveness of early anti-platelet therapy after alteplase for acute ischemic stroke 5