Adjunctive Antithrombotic Medications to Acute Reperfusion Therapy: Current Evidence and Future Directions

Thrombolytics and mechanical thrombectomy are standard of care therapies for the treatment of acute ischemic stroke. Optimizing reperfusion beyond these 2 interventions is a critical next step to improving patient outcomes. The utility of antithrombotic medications is well-established for secondary stroke prevention, but their role as adjunctive therapies to achieve or optimize reperfusion in the acute setting remains investigational. This article discusses the rationale for the use of adjunctive antithrombotic medications in combination with reperfusion therapies and reviews key trials exploring their use. We will use the term adjunctive to refer to any antithrombotic intervention that is added acutely to the standard of care of thrombolysis or thrombectomy to improve patient outcomes. A brief discussion on the future of adjunctive therapies for current reperfusion strategies and the best use of antithrombotic medications in the hospital setting are additionally presented.