Platelet/von Willebrand Factor Inhibitors to the Rescue of Ischemic Stroke

Abstract

In the last few decades, there have been dramatic advances in the treatment of acute coronary syndromes, leading to a substantial reduction in the actual mortality and disability of the most frequent atherothrombotic diseases. To make brief a long story of clinical success, coronary care units initially managed to reduce mortality by controlling severe arrhythmias and heart failure. Further reduction of major adverse cardiac events was subsequently achieved through early coronary artery reperfusion by means of pharmacological thrombolysis and percutaneous coronary intervention with stent deployment. The development and improved use of anticoagulant and antiplatelet drugs has also been crucial for further clinical progress. See accompanying article on page 1949 Clinicians are well aware that progress was much smaller for ischemic stroke, the second most frequent atherothrombotic disease. Specialized intensive care units are helpful, but their impact on stroke mortality and disability is not as great as that of cardiac care units. Pharmacological thrombolysis is only effective in the limited therapeutic window of 3 to 4.5 hours after the onset of symptoms of cerebral ischemia (the sooner the treatment, the higher the efficacy), and the risk of intracerebral bleeding looms large. Moreover, antiplatelet and …