Selections of Antithrombotic Agents During Acute Stage

Abstract

There are two major classes of antithrombotic agents that can be used in acute stroke settings, namely, antiplatelet agents and anticoagulant agents. Aspirin is recommended to use as soon as possible (within 48 h after stroke onset) for acute ischemic stroke patients. Recently, short-term dual antiplatelet therapy (aspirin plus clopidogrel) has been indicated to be safe and superior to aspirin in acute ischemic stroke patients in China. However, the dual antiplatelet therapy with aspirin and clopidogrel is not recommended as stroke prevention for the long term. Early anticoagulation occasionally might be used for certain stroke patients, although it is not recommended in general. Oral anticoagulation is recommended for secondary stroke prevention in patients with cardioembolic stroke. However, the initial timing of anticoagulation in acute stroke setting in cardioembolic stroke patients remains unclear. Further prospective studies to evaluate the safety, efficacy, optimal term, or optimal selections of antithrombotic agents will be needed for the acute ischemic stroke patients, considering the etiology of stroke. Physicians should consider the etiology of stroke (at least, cardioembolic stroke or non-cardioembolic stroke) to select the antithrombotic agents.