Skip to main content
SpringerLink
Log in

Antithrombotic and Thrombolytic Therapy for Ischemic Stroke

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Anthithrombotic therapy is widely used as primary and secondary preventative treatment for ischemic cerebrovascular disease. Aspirin modestly reduces the risk for subsequent ischemic stroke after a transient ischemic attack or initial stroke. Adding dipyridamole may enhance this benefit. Ticlopidine confers a small additional benefit, but with more side effects and cost. The best dose of aspirin remains unsettled, but recent studies support the concept of very early initiation of treatment. Intravenous and subcutaneous heparin or low-molecular-weight heparin is not recommended because of enhanced bleeding side effects, unless venous thrombosis in debilitated patients is a concern. Thrombolytic therapy with rt-PA was recently demonstrated to improve outcome in ischemic stroke patients treated within 3 hours of onset. However, the risk-benefit ratio is narrow because of the substantial risk for intracerebral hemorrhage with rt-PA. An enhanced ability to identify patients at risk for bleeding and newer thrombolytic drugs may expand the utility of this therapy, as would extending the time window beyond the current 3-hour period. Clinicians should anticipate continued advances in the fields of antithrombotic and thrombolytic therapy for ischemic stroke over the next few years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The Canadian Cooperative stroke. N Engl J Med 1978; 299:53–59.

    Google Scholar 

  2. Antiplatelet Trialists' Collaboration. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 1994;308:81–106.

    Google Scholar 

  3. Barnett HJM, Eliasziw M, Meldrum HE. Drugs and surgery in the prevention of ischemic stroke. N Engl J Med 1995;332:238–248.

    PubMed  Google Scholar 

  4. UK-TIA Study Group. The United Kingdom transient ischemic attack (UK-TIA) aspirin trial; final results. J Neurol Neurosurg Psych 1991;54:325–334.

    Google Scholar 

  5. The Dutch TIA Trial Study Group. A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 1991;325:1261–1266.

    Google Scholar 

  6. The SALT Collaborators Group. Swedish low-dose trial of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 1991;338:1345–1349.

    Google Scholar 

  7. The ESPS Group. European Stroke Prevention Study. Stroke 1990;211:1122–1130.

    Google Scholar 

  8. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1995;143:1–13.

    Google Scholar 

  9. Gent M, Blakely JA, Easton JD, et al. The Canadian-American ticlopidine study (CATS) in thromboembolic stroke. Lance 1989;1:1215–1220.

    PubMed  Google Scholar 

  10. Hass WK, Easton JD, Adams HP, et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med 1989;321:501–507.

    PubMed  Google Scholar 

  11. Caprie Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–1339.

    Google Scholar 

  12. Genton E, Barnett HJM, Fields WJ, Lent M, Hoak JC. Cerebral ischemia: The role of thrombosis and of antithrombotic therapy. Stroke 1977;8:150–175.

    PubMed  Google Scholar 

  13. Marsh EE, Adams HP, Biller J, et al. Use of antithrombotic drugs in the treatment of acute ischemic stroke: A survey of neurologists in practice in the United States. Neurology 1989;39:1631–1634.

    PubMed  Google Scholar 

  14. Duke RJ, Bloch RF, Turpie AGG, Trebilcock R, Bayer N. Intravenous heparin for the prevention of stroke progression in acute partial stable stroke. Ann Intern Med 1986;105:825–828.

    PubMed  Google Scholar 

  15. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): A randomized trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet 1997;349: 1569–1581.

    Google Scholar 

  16. Kay R, Wong KS, Ling Y, et al. Low-molecular-weight heparin for the treatment of acute ischemic stroke. N Engl J Med 1995;333:1588–1593.

    PubMed  Google Scholar 

  17. Trial of Org10172 in acute stroke treatment. Presented at the 6th European Stroke Conference, Amsterdam, May 1997.

  18. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 1997;349:1641–1649.

    Google Scholar 

  19. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.

    Google Scholar 

  20. Hacke W, Kaste M, Fieschi, C, et al. for The ECASS Study Group. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 1995;274:1017–1025.

    PubMed  Google Scholar 

  21. Donnan GA, Davis SM, Chambers BR, et al. for the Australian Streptokinase (ASK) Trial Study Group. Streptokinase for acute ischemic stroke with relationship to time of administration. JAMA 1996;276:961–966.

    PubMed  Google Scholar 

  22. Multicenter Acute Stroke Trial-Europe Study Group. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 1996;335:145–150.

    Google Scholar 

  23. Multicenter Acute Stroke Trial-Italy (MAST-I) Group. Randomized controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 1995;346:1509–1514.

    Google Scholar 

  24. Del Zoppo GJ, Higashida RT, Furlan AJ, et al. The Prolyse in Acute Cerebral Thromboembolism Trial (PROACT); results of 6 mg dose tier. Stroke 1996;27:164.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Memorial Health, University of Massachussetts Medical School, Worcester, Massachussetts

    Marc Fisher

Authors
  1. Marc Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fisher, M. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke. J Thromb Thrombolysis 7, 165–169 (1999). https://doi.org/10.1023/A:1008889605137

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008889605137

Search

Navigation