Stroke: Thrombolysis and Antithrombotic Therapy

Antithrombotic therapy is the cornerstone of secondary stroke prevention. Medical practitioners have access to an armamentarium of drugs that include aspirin, clopidogrel, and aspirin-dipyridamole combinations, for the patient at high risk of atherothrombosis. Recombinant tissue plasminogen activator (rt-PA) is the only drug approved in the United States and Europe for the treatment of acute ischemic stroke. The usefulness of rt-PA has now been demonstrated up to 4.5 hours after the onset of stroke symptoms, for select patients. Alternative approaches to rt-PA for treatment of acute ischemic stroke include novel thrombolytic agents and combinations of platelet glycoprotein receptor antagonists with rt-PA. This chapter will review advances in the therapeutic management and prevention of ischemic stroke, including antithrombotic agents and thrombolytics.