Key result
Early IV thrombolysis followed by etiology-driven secondary prevention anchors acute ischemic stroke management.
This review summarizes current antithrombotic and reperfusion strategies for acute ischemic stroke, highlighting the emerging role of tenecteplase and tailored secondary prevention.
Tenecteplase simplifies AIS thrombolysis administration; leaves open comparative safety versus alteplase pending randomized extended-window trials.
Regarding AIS, reperfusion through IV thrombolysis remains the cornerstone of treatment, alongside mechanical thrombectomy in eligible patients. International guidelines recommend Alteplase within 4.5 hours of symptom onset; however, advanced neuroimaging may allow for the extension of this treatment window in selected patients. Tenecteplase, with its favorable pharmacokinetics and simplified administration, is emerging as an alternative. Early secondary prevention is strictly dependent on stroke etiology and consists of antiplatelets, oral anticoagulants, and aggressive risk factor control. Cardioembolic strokes require timely oral anticoagulation, while noncardioembolic minor ischemic strokes or high-risk transient ischemic attacks benefit from short-term dual antiplatelet therapy.
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Laudisi et al. (2026) studied this question. Antithrombotic management of acute ischemic stroke relies on early intravenous thrombolysis followed by etiology-driven secondary prevention with antiplatelets or oral anticoagulants.
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